Employment Application

Instructions to Applicant: This veterinary hospital is an equal opportunity employer and will not discriminate, or tolerate discrimination, against any employee or applicant in any manner prohibited by law. Disabled applicants can request any accommodation needed to enable them to complete the application. Any applicant who provides information not requested will be automatically rejected.

Questions regarding this application should be directed to the employment interviewer. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Conditions of employment are stated at the end of this form. Please read carefully before you sign this application. (Application must be completed in full even if attaching a resume).

Which location are you applying for?*

Last Name*

First Name*

M.I.

Date of Application*

Date

Address*

Street Address

Apartment/Unit #

CityState / Province

Postal / Zip Code

Phone*

Email*

example@example.com

Date Available to Begin Work*

Date

Days/Nights Available*

Desired Salary*

Position Applied for*

Full Time or Part Time*

Are you 18 years of age?*

YesIf not, you may be required to provide authorization to work.

Are you legally eligible to be employed in the US?*

YesNo

Proof of eligibility and identity will be required upon employment offer.

Have you ever worked for this company?*

YesNo

If so, when?

High School*

Location*

Years Completed*

Diploma Received*

College (1)

Location

Years Completed

Degree Received

College (2)

Location

Years Completed

Degree Received

Company (1)*

Phone*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Supervisor*

Job Title*

Starting Salary*

Ending Salary*

Responsibilities*

From Date* To Date*

Reason for Leaving*

May we contact your previous supervisor for a reference?*

YESNO

Company(2)

Phone

Address

Street Address

Street Address Line 2

CityState

Zip Code

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From Date To Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Company(3)

Phone

Address

Street Address

Street Address Line 2

CityState

Zip Code

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From Date To Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Have you ever been discharged from any employment or asked to resign?*

YESNO

If yes, explain*

Explain any period between jobs:*

Is there anything that would interfere with your regular attendance and punctuality if you are offered a job?*

YesNo

If Yes, explain*

Can you perform the essential functions of the position, either with or without reasonable accommodation? (If you have any questions as to the essential functions of the position, please ask the interviewer)*

YesNo

Have you competed any special courses, seminars, or training that would enable you to perform the position for which you are applying?

Please list any professional license or certification you believe should be considered relevant to the position applied for on this application.

Please list any professional, trade, business or civic organizations that pertain to the position in which you are applying, and explain any offices held. (Omit any organization that reflects your race, color, religion, age, sex, sexual orientation, marital status, or disabilities)

List any other experience, skills, or other qualifications including hobbies which you believe should be considered in evaluating your qualifications for employment. (Omit any that reflect your race, color, religion, age, sex, sexual orientation, marital status, or disabilities)

Please indicate any prior experience in the Armed Forces of the Unites States or state militia, including dates of service and relevant training/experience received during military duty.

Reference 1*

Reference 2*

Reference 3*

Resumé

Attach current resumé, if able.

Signature Required: (for the following disclaimers)

"By signing the application, I declare that the information provided by me is complete, accurate, and true to the best of my knowledge. I understand that any falsification, misrepresentation, or omission on this application (or any other accompanying or required documents) may preclude an offer of employment, or may result in a withdrawal of an employment offer, or may result in discharge of my employment if I am already employed at the time of falsification, misrepresentation or omission is discovered."

"I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information, and I also release the employer from all liability that might result from making an investigation."

"I understand that this application will remain on file for no longer than 6 months. Consideration for new employment after 180 days requires a new application."

"If hired, I agree to abide by all of the company rules and regulations. I agree that, just as I have, if hired, the right to terminate my employment at any time, with or without cause and with our without notice, the company may terminate my employment at any time, with our without cause or notice. I understand that no manager or representative of the company, other than its owner or his/her designee, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing either now, in the past, or in the future. I further understand that such agreement must be in writing, and signed by the owner or his/her designee for it to be binding on either myself, or the company. I further understand that this statement supersedes any prior oral or written understanding, and bars any future oral understanding to the contrary."

"I acknowledge that I have read and understand the above statements, and herby grant permission to confirm the information supplied on the application by me."

Signed by Applicant*

Date*

Date

EMPLOYMENT APPLICATION

APPLICANT INFORMATION

EDUCATION

Employment History

Attendance and Punctuality Information

Additional Experience or Qualifications

References