BRVC Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religous belief, sex, age, national origin, ancestry, physical or mental disability, or vetran status.

Name

First NameMiddle NameLast Name

Preferred Pronouns

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Are you working anywhere right now? If so, please list days and hours:

When can you start?

Desired Wage $

Are you looking for full-time or part-time employment?

What days and hours are you available? (please be specific)

Have you ever been convicted of a misdemeanor or felony? (This will not necessarily affect your application, but a criminal background check might be ran on you and false information provided now will make you ineligible for employment)

If yes, please describe conditions:

Education

High School Name and Location:    Type a label
College Name and Location:
Major or Degree:
Other training:

In addition to your work history, are there other skills, qualifications, or experience that we should consider?

Please select all that apply:

If so, where did you get your certificate?

Employement History (Start with most recent employer)

1) Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Started:   Date*   Date Ended: Date*
Starting Wage:   Number*   Ending Wage:   Number*
Starting Position:      Ending Position:   *
Name of Supervisor:   *
Responsibilities:   *
Reason for leaving:   *
May we contact?   Yes   No*

Do you wish to add another previous employer?

2) Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Started:   Date*   Date Ended: Date*
Starting Wage:   Number*   Ending Wage:   Number*
Starting Position:      Ending Position:   *
Name of Supervisor:   *
Responsibilities:   *
Reason for leaving:   *
May we contact?   Yes   No*

Do you wish to add another previous employer?

3) Company Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Started:   Date*   Date Ended: Date*
Starting Wage:   Number*   Ending Wage:   Number*
Starting Position:      Ending Position:   *
Name of Supervisor:   *
Responsibilities:   *
Reason for leaving:   *
May we contact?   Yes   No*

List 3 non-family/friend professional references you have known for at least 3 years.
1) Name: * Phone: * Relation: *
2) Name: * Phone:* Relation: *
3) Name:* Phone: * Relation: *

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

Typed Name as Signature/ Date

Bluebonnet Riverside Vet Clinic Application for Employment