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Employment Application Form
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
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Armenia
Aruba
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Austria
Azerbaijan
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Bahrain
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Belgium
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Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
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Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
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Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
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Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
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Slovenia
Solomon Islands
Somalia
Somaliland
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South Ossetia
South Sudan
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Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
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Switzerland
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Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
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Tokelau
Tonga
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4
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Home Phone
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Alternate Contact
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5
We have agreements with other veterinary clinics in this area to share applications if we are not hiring for a particular position immediately. May we have permission to share your information?
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No
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6
Position Desired
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RVT
VetAsst
Reception
Kennel Asst
Groomer
Vet Tech
Veterinarian
Animal Care Assistant
Other
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7
If Other, Please specify
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Date You Can Start
Desired Salary Per Hour
Per Week Salary
How many hours/week wanted?
How many days per week wanted?
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9
Please list any schedule restrictions
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10
List any friends or family who work(ed) here
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11
Why do you want to work for us?
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12
Some positions may have age and/or driving requirements
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13
Do you have a valid driver's license?
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14
Are you
16
years of age or older?
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15
Are you
18
years of age or older?
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Yes
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16
Are you legally authorized to work in the U.S.?
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17
If still in high school, which grade currently?
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18
High School
High School
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Start Date
End Date
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No
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Graduate?
Honors
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College
College
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End Date
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No
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Degree?
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Other School
Other School
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End Date
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No
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Degree?
Honors / Awards
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21
Any additional skills?
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22
#1
Group/Activity
Dates Involved
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23
#2
Group/Activity
Dates Involved
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24
1# Job
Company
Phone Number
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Type of Business
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25
Supervisor's Name
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No
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May we contact this person?
Job Title
Starting Rate Per Hour
Ending Rate Per Hour
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26
Job Duties
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27
Starting Date
Ending Date
Reason for Leaving
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28
2# Job
Company
Phone
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Type of Business
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29
Supervisor's Name
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Yes
No
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No
May we contact this person?
Job Title
Starting Rate Per Hour
Ending Rate Per Hour
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30
Job Duties
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31
Starting Date
Ending Date
Reason for Leaving
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32
3# Job
Company
Phone
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Type of Business
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33
Supervisor's Name
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Yes
No
Please Select
Please Select
Yes
No
May we contact this person?
Job Title
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Ending Rate Per Hour
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34
Starting Date
Ending Date
Reason for Leaving
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35
Job Duties
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36
#1 Reference
Full Name
Phone #
Relationship
How Long Acquainted?
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37
#2 Reference
Full Name
Phone #
Relationship
How Long Acquainted?
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38
#3 Reference
Full Name
Phone #
Relationship
How Long Acquainted?
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39
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my termination.
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