GSVC 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
Position applying for*

Certified Veterinary TechnicianVeterinary AssistantReceptionistGroomerKennel AssistantVeterinarian
Available start date *

MonthDayYear
Date
What is your current employment status?*

EmployedSelf-employedUnemployedStudent
Availability*

Year-Round, permanentSeasonal or Temporary (please describe limitations)
Hours requested*

Full TimePart 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?*

YesNo (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?*

YesNo
If lifting restrictions, please explain:
Do you have experience in the field of veterinary medicine?*

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.)*
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.*

YesNo
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.*

YesNo
Do you use illegal drugs?*

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

YesNo
Do you smoke?*

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

YesNo
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?

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*
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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