AMC EMPLOYMENT APPLICATION

ANIMAL MEDICAL CLINIC

Employment Application
Personal Information
Name

First NameMiddle NameLast Name
Address

Address

Street Address Line 2

CityState

Zip Code
Email Address
example@example.com
Phone Number
Employment Desired
Position
Date you can start

MonthDayYear
Date
Salary Desired
Are you employed now?

YesNo
If so, may we inquire of your present employer?

YesNo
Are you acquainted and/or related to any of our current staff?

YesNo
If so....who?
Have you ever applied with us before

YesNo
How did you hear about the position
Are there any days/shifts or hours you are NOT available to work?

YesNo
When
Please check times you are available to work:

DaysWeekendsHolidays
Background Information

Please note – answering yes to these questions do not constitute an automatic bar to employment – factors such as date of offense, seriousness and nature of violation and position applied for will be taken into account.
Have you ever been convicted of a misdemeanor?

YesNo
If yes explain
Have you ever been convicted of a Felony?

YesNo
If yes explain
Have you ever you had a deferred adjudication or other judicial outcome?

YesNo
If yes explain
Education History
High School
Name/City/State for High School
Did you graduate?

YesNo
Grade Average
Major/Minor Course of Study and Degree
College
Name/City/State for College
Did you graduate?

YesNo
Grade Average
Major/Minor Course of Study and Degree
Graduate School
Name/City/State for Graduate School
Did you graduate?

YesNo
Grade Average
Major/Minor Course of Study and Degree
Other Schooling
Name/City/State for Military, Trade, Business, Night or Correspondence Courses
Did you graduate?

YesNo
Grade Average
Major/Minor Course of Study and Degree
Name/City/State for GED or Other Professional Certification(s) or Training
Did you graduate?

YesNo
Grade Average
Major/Minor Course of Study and Degree
Employment History

Please list your employment history below starting with your current or most recent job. (Please include any temporary work). Please show LAST position FIRST.
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason For Leaving
Company Name
Job Title
Address

Address

Street Address Line 2

CityState

Zip Code
Phone Number
Supervisor
Key Responsibilities and Accomplishments
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason For Leaving
Company Name
Job Title
Address

Address

Street Address Line 2

CityState

Zip Code
Phone Number
Supervisor
Key Responsibilities and Accomplishments
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason For Leaving
Company Name
Job Title
Address

Address

Street Address Line 2

CityState

Zip Code
Phone Number
Supervisor
Key Responsibilities and Accomplishments
References
Give below the names of three persons not related to you, whom you have known at least one year.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
How do you know them?
Years Known
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
How do you know them?
Years Known
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
How do you know them?
Years Known
Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

I understand and agree my employment is at will, which means that it is for no specified period of time and may be terminated by me or Animal Medical Clinic at any time without prior notice for any reason.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relative federal and state laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. I also understand that a poor credit history or convictions will not automatically result in disqualification from employment."

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

I certify that I have read, understand and agree to the above.
Date

MonthDayYear
Date
Signature

Clear
This application for employment is good for 30 days only. Consideration for employment after 30 days requires a new application. Animal Medical Clinic is an equal opportunity employer and does not discriminate in employment on the basis of age, race, color, religion, sex, national origin, marital status, military status, presence of a non-job related medical problem or physical impairment, or on any basis prohibited by federal or state law.
Animal Medical Clinic Employment Application 2024
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