YesNo

O O Do you smoke?

O O Are you allergic to pets?

O O Are you willing to be involved in the care of a pet?

O O Do you have a valid driver's license?

License number and state

O O Have you ever had your license revoked?

If yes, explain

O O Can you swim?

O O Do you have first-aid training?

Last date updated

O O Do you have CPR training?

Last date updated

O O Do you have any health problems that might affect your job performance?

If yes, explain

O O Have you ever been convicted of a felony?

If yes, please explain

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