Coastal Animal Medical Center Application

Full Name*

Preferred Name

Home Phone*

Mobile Phone*

Address*

Email address*

example@example.com

Position Sought*

We are open 7days/week. You may be scheduled from 7:30am-8:00pm. List the hours you are unavailable*

Desired Pay Range*

Full/Part time*

Are you currently employed?*

High School attended and last year attended*

Did you graduate?*

YesNoGED

College/University

Major

Did you graduate?

YesNo

Specialized Training, Trade School, etc*

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.*

Please list clubs, associations and unions of which you are a member or volunteer.*

Please list the number and type of pets you have at home.*

Do you agree to comply with a zero tolerance illegal drug and alcohol policy?*

YesNo

Have you ever been convicted of a felony?*

NoYes

Are you able to work legally in the United States?*

YesNo

List any small animals you are scared of or nervous around.*

Do you understand that this job will require lifting at least 50 pounds repeatedly?*

Yes

Do you acknowledge this job requires standing on concrete floors for long periods of time?*

Yes

Employment History (please list beginning from most recent)

Dates Employed*

Date

Company Name*

Location*

Title/Role*

Starting Pay*

Ending Pay*

Supervisor*

Tasks Performed*

Reason for leaving this job*

May we contact this employer?*

Phone #*

Dates Employed*

Company Name*

Location*

Title/Role*

Starting Pay*

Ending Pay*

Supervisor*

Tasks Performed*

Reason for leaving this job*

May we contact this employer?*

Phone #*

Dates Employed*

Company Name*

Location*

Title/Role*

Starting Pay*

Ending Pay*

Supervisor*

Tasks Performed*

Reason for leaving this job*

May we contact this employer?*

Phone #*

Do you have a professional license? If so, what type?

Expiration date

License Number

By signing this application below I agree that the information contained in this application is true to the best of my knowledge; I filled out this application myself; and if I am hired at Coastal Animal Medical Center and any of this information is found to be false, management has the right to terminate my employment immediately.

Date*

Date

Signature