Careers Form

Careers Form
Name*

First NameLast Name
Social Security *
Driver's License*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Position(s) applied for (check all that apply)*

VeterinarianVeterinary TechnicianVeterinary AssistantReceptionistAnimal Care Attendant (Kennel)Other
If Other, Please Specify*
Availability*

Year-Round PermanentSeasonalTemporary
Hours you are looking for*

Part time onlyFull time onlyAs Needed
If applying for part time only, how many hours do you want to work? * to * hours per week.
Hours you are routinely available to work*
What rate of pay do you expect?*
What do you want to work at an Animal Clinic?*
What are your career goals for the next 2 years?*
What are your career goal for the next 5 years?*
Have you been convicted of a felony, or misdemeanor or are you presently/ formally charged with committing any criminal offense?*

YesNo (Do not include any traffic violations, juvenile offenses, military convictions, except by general court martial)
If the answer is yes, furnish details of conviction, offense, location, date and sentence*
In the past three years, have you ever knowingly used any narcotics, amphetamines or barbiturates, other than those prescribed to you by a physician?*

YesNo
If yes, furnish details.*
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 of other crimial conduct?*

YesNo
Most recent school you attended?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Degree or grade level attained?
GPA?
Awards
Do you have any certifications, degrees, awards or special skills we should know about?
Experience
Current or Most Recent Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position Title
Duties
Reason you left the position
Hourly rate of pay
Add Another Experience?

YesNo
Previous Employer #1
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position Title
Duties
Reason you left the position
Hourly rate of pay
Add Another Experience?

YesNo
Previous Employer #2
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Position Title
Duties
Reason you left the position
Hourly rate of pay
Please describe an other relevant experience (volunteer, animal related hobby,etc.)
Please list your hobbies
Is there anything else you would like us to know when considering your application?
Reference
Name
Relationship
Phone Number
Please enter a valid phone number.
How long have they known you?
Add Another Reference?

YesNo
Reference #2
Name
Relationship
Phone Number
Please enter a valid phone number.
How long have they known you?
Add Another Reference?

YesNo
Reference #3
Name
Relationship
Phone Number
Please enter a valid phone number.
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, may 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 statements 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 the Animal Clinic to check employment references and verify education information provided on this employment application and as disclosed in the interview process.
- I authorize the Animal Clinic to run a credit history check and criminal history background check as a condition of employment.
- I release the Animal Clinic and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process.
- I have read the job description and I am fully capable of performing all tasks listed.
Lili Veterinary Hospital has an Alternative Dispute Resolution (ADR) Program. The ADR Program requires that all work-related disputes be submitted to an informal dispute resolution process, including mediation, final and binding arbitration, or both. The ADR Program applies to parties including the employer, applicants for employment, employees or former employees. Acceptance of the ADR program is a condition of submitting an application for employment, employment and continued employment.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Careers Form

Experience

Reference

Reference #2

Reference #3