Employment Application

Submission Date *

Date

Name *

First Name Last Name

Address *

Current Address

Street Address Line 2

City State

Zip Code

Phone *

Email

example@example.com

Position applying for *

Certified Veterinary Technician Veterinary Assistant Receptionist Groomer Kennel Assistant Veterinarian

Available start date *

Date

What is your current employment status? *

Employed Self-employed Unemployed Student

Availability *

Year-Round, permanent Seasonal or Temporary (please describe limitations)

Hours requested *

Full Time Part Time (20-30 hours per week) Part Time (10-20 hours per week) Part Time (less than 10 hours per week)

Are you willing and able to work weekends and holidays? *

Yes No (some weekend and Holiday hours may be required)

This job requires lifting up to and exceeding 50 pounds. Do you have any restrictions that would hinder your ability to perform this task? *

Yes No

If lifting restrictions, please explain:

Do you have experience in the field of veterinary medicine? *

Yes No

Why do you want to work for Family Pet Hospital, LLC? *

What are your career goals for the next 2 years? *

What are your career goals for the next 5 years? *

Please describe any relevant experience (volunteering, animal related hobby, etc.) *

Within the past five years, have you been convicted of a felony, or within the past two years, of any misdemeanor or are you presently formally charged with committing any criminal offense? (Do not include any traffic violations, juvenile offenses, or military convictions, except by general court martial If the answer is yes, you will be asked to provide further details. *

Yes No

In the past three years, have you ever knowingly used any narcotics, amphetamines, or barbiturates, other than those prescribed to you by a physician? If the answer is yes, you will be asked to provide further details. *

Yes No

Do you use illegal drugs? *

Yes No

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

Yes No

Do you smoke? *

Yes No

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

Yes No

Please list all the pets you own: (include names, species & age)

Who is your current veterinarian?

City

State

Are all your pets up to date with all their routine recommended veterinary care?

Yes No

Most recent school you attended *

Degree or grade level attained *

GPA *

Do you have any certifications, degrees, awards, or special skills we should know about?

Current or Most Recent Employer *

From (mm/dd/yy) *

To (mm/dd/yy) *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Phone *

Position Title *

Duties *

Reason you left (or are leaving) the position *

Do you know any current or former Family Pet Hospital or Galena Square Vet employees)? If yes, please list:

Reference #1 Name *

Relationship *

Phone *

How long have they known you? *

Reference #2 Name *

Relationship *

Phone *

How long have they known you? *

Reference #3 Name *

Relationship *

Phone *

How long have they known you? *

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 statement 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 Family Pet Hospital, LLC to check employment references and verify education information provided on this employment application and as disclosed in the interview process. I authorize Family Pet Hospital, LLC to run a credit history check and criminal history background check as a condition of employment. I release Family Pet Hospital, LLC and al providers of information from any liability as a result of furnishing and receiving any information related to the hiring process. *

Yes, I understand and agree to these terms

Signature

Clear

Please upload a PDF version of your cover letter, resume, and any additional references. *

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