Employment Application

Employment Application
Submission Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Current Address

Street Address Line 2

CityState

Zip Code
Phone*
Format: (000) 000-0000.
Email
example@example.com
Certified Veterinary TechnicianVeterinary AssistantReceptionistGroomerKennel AssistantVeterinarian
Available start date *

MonthDayYear
Date
EmployedSelf-employedUnemployedStudent
Year-Round, permanentSeasonal or Temporary (please describe limitations)
Full TimePart Time (20-30 hours per week)Part Time (10-20 hours per week)Part Time (less than 10 hours per week)
YesNo (some weekend and Holiday hours may be required)
YesNo
If lifting restrictions, please explain:
YesNo
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.)*
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Please list all the pets you own: (include names, species & age)
Who is your current veterinarian?
City
State
YesNo
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

CityState

Zip Code
Phone*
Format: (000) 000-0000.
Position Title*
Duties*
Reason you left (or are leaving) the position*
Previous Employer*
From (mm/dd/yy)*
To (mm/dd/yy)*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone*
Format: (000) 000-0000.
Position Title*
Duties*
Reason you left (or are leaving) the position*
Previous Employer
From (mm/dd/yy)
To (mm/dd/yy)
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone
Format: (000) 000-0000.
Position Title
Duties
Reason you left (or are leaving) the position
Previous Employer*
From (mm/dd/yy)*
To (mm/dd/yy)*
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone*
Format: (000) 000-0000.
Position Title*
Duties*
Reason you left (or are leaving) the position*
Previous Employer*
From (mm/dd/yy)*
To (mm/dd/yy)*
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone*
Format: (000) 000-0000.
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*
Format: (000) 000-0000.
How long have they known you?*
Reference #2 Name*
Relationship*
Phone*
Format: (000) 000-0000.
How long have they known you?*
Reference #3 Name*
Relationship*
Phone*
Format: (000) 000-0000.
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
Please upload a PDF version of your cover letter, resume, and any additional references. *

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