Pet Wellness Animal Hospital Job Application Form

Name of Applicant*

PrefixFirst NameMiddle NameLast Name

Applicant's email address*

Applicant's telephone number*

Area CodePhone Number

Applicant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Date of Birth of Applicant*

MonthDayYear

Job applying for:*

Veterinary TechnicianVeterinary AssistantReceptionist/Client Care CoordinatorAnimal Care Attendant/Kennel

Availability:*

Year round, permanentTemporary or seasonalOther

Hours requested:*

Full time onlyPart time onlyFull or part time as needed

If applying for part time, how many hours per week are you available?*

Why do you want to work at Pet Wellness Animal Hospital?*

What are your career goals in 2 years?*

What are your career goals in 5 years?*

What is your current employment status?*

EmployedSelf-employedUnemployedStudent

Most current or most recent employer*

Most current or recent employer address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Most current or recent employer telephone number*

Area CodePhone Number

Reason you left or want to leave current or most recent employer*

Previous Employer #1*

Previous Employer #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Previous Employer #1 telephone number*

Area CodePhone Number

Reason you left employer #1*

Previous Employer #2*

Previous Employer #2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Previous Employer #2 telephone number*

Area CodePhone Number

Reason you left employer #2*

Please describe any other relevant experience:

Is there anything else you would like us to know when considering your application?

Have you been convicted of a felony, or misdemeanor or are you presently or formally charged with committing any criminal offense? (Do not include any traffic violations, juvenile offenses, military convictions, except by general court martial.)*

YesNo

If you answered yes, please furnish details of conviction, offense, location, date and sentence*

In the past three years, have you ever knowingly used any narcotics, amphetamines or barbiturates, other than those prescribed to you by a physician?*

YesNo

Do you use illegal drugs?*

YesNo

Would you agree to and pass periodic routine drug tests?*

YesNo

Do you smoke?*

YesNo

Have you ever been terminated from a job because of stealing of other criminal conduct?*

YesNo

First Name Last Name Street Address* Address Line 2* City* State* Zip* Email Area Code Phone Number

I understand that any verbal or written statement that is false, fraudulent or misleading that is contained in this application or attached materials, or made in the course of any related employment process, whether made by me or by others at my request, will result in rejection of my application, denial of employment, or dismissal
from service if discovered after employment, and under some circumstances, may result in prosecution for a crime.

I certify that all statements contained herein are true and complete.
I understand that if hired, I must prove that I am legally authorized to work in the United States.
I authorize the Pet Wellness Animal Hospital to check employment references and verify education information provided on this employment application and as disclosed in the interview process.
I authorize the Pet Wellness Animal Hospital to run a credit history check and criminal history background check as a condition of employment.
I release the Pet Wellness Animal Hospital and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process.
I am fully capable of performing all tasks associated with the desired job.

I agree that the information herein are true and correct*

Yes

Signature*

Employment Application

Employment History

Other

References