Main Street Veterinary Hospital Employment Application

Main Street Veterinary Hospital

Employment application
APPLICANT INFORMATION
Name

First Name, MILast Name
Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Date available to start

MonthDayYear
Date available to start?
Desired salary $ per hour.
Position Applied for
Are you a citizen of the United States blanks Yes or No
If no, are you authorized to work in the U.S? blank Yes or No if so, when?
Have you ever been convicted of a felony? Type a label Yes or No if yes please explain.
TELL US ABOUT YOURSELF
Why do you think that you would be a good fit at Main Street
Are you an early riser (yes or no) blanks ?
What is your ideal schedule? Do you have any restrictions?
Can you lift 40lb off the ground unassisted
EDUCATION
High School
Address
From- To
Did you graduate? Yes or No
Degree
College
Address
From- To
Did you graduate? Yes or No
Degree
Other
Address
From To
Did you graduate YES NO
Degree
Previous Employment
Company 1
Phone ( )
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From To
Reason for Leaving
May we contact your previous employer for a reference? Yes or No
Company 2
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From To
Reason for Leaving
May we contact your previous supervisor for a reference? Yes or No
Company 3
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From To
Reason for Leaving
May we contact your previous supervisor for a reference YES NO
Military Service
Branch
From To
Rank at Discharge
Type of Discharge
If other than honorable explain
DISCLAIMER AND SIGNATURE
I hereby authorize Main Street Veterinary Hospital to verify all the information I have provided to obtain and disclose all personal information or all information regarding my person. This verification may be performed by phone or in writing, notably but not exclusively, before personal information agents, former employers, associations, current employers, public agencies, para-public agencies, and or any other source I provide below as a reference.

I authorize the individuals and organizations named below to furnish any and all information requested by the company listed above and/or its representatives, on its behalf, free of all and any liability.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Date

MonthDayYear
Date
REFERENCES

Please list three professional references.
Full Name
Relationship
Company
Phone
Email
example@example.com
Full Name
Relationship
Company
Phone Number
Please enter a valid phone number.
Email
example@example.com
Full Name
Relationship
Company
Phone Number
Please enter a valid phone number.
Email
example@example.com
Should be Empty:

Main Street Veterinary Hospital

APPLICANT INFORMATION

TELL US ABOUT YOURSELF

EDUCATION

Previous Employment

Military Service

DISCLAIMER AND SIGNATURE

REFERENCES