Employment Application

Employment Application

An Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, genetic information or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.
Name:*

First NameLast Name
E-mail Address:
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
How were you referred to us?*

Walk-InEmployeeFacebookIndeedOther (please specify)LinkedIn
What employee referred you?
What do you know about us:
Upload Resume:

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Job Skills & Training
Training or Certifications (If Any):
Describe your skills:*
What makes you believe that you are a fit for this position and our culture?*
Employment Desired
The position you are applying for*

Customer Service RepresentativeKennel AssistantVeterinary AssistantVeterinary Technician
The clinic you want to be employed at*

Albion Animal CenterAnimal Hospital of MedvilleAnimal Hospital of OrwellWestern Reserve Animal ClinicOpen for discussion
Do you want to work*

full-timepart-timeseasonalopen for discussion
Please upload Veterinary Technician registration, certification or license here

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Date you can start
Have you been employed with one of our clinics before?
When and what clinic were you employed?
Are you currently employed?
Have you ever applied to this company before?
Education history
Name and location of school/college/university:
Years attended:
Did you graduate?
Subjects studied:
Add another school?

YesNo
2nd Name and location of school/college/university:
Years attended 2nd school/college/university:
Did you graduate from 2nd school/college/university?
Subjects studied 2nd school/college/university:
Former Employment
Employer name:
Employer phone:
Please enter a valid phone number.
Employment position/title:
Dates employed:
Reason for leaving:
May we contact your previous employer for a reference?
Who do we ask for at that employer?
Add another employer?
2nd Employer name:
2nd Employer phone:
Please enter a valid phone number.
2nd Employment position/title:
Dates employed at 2nd employment:
Reason for leaving 2nd employment:
May we contact your previous 2nd employer for a reference?
Who do we ask for at the 2nd employer?
Have you ever been dismissed from or asked to resign from an employment position, or engaged in acts of unprofessional conduct?
References

Please list one (1) reference that is familiar with your work life and one (1) reference that is familiar with your personal life.
Name of Work Reference:*

First NameLast Name
Phone Number*
Years Known:*
Name of Personal Reference:*

First NameLast Name
Phone Number*
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 into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
File Upload - for any other files such as cover letter, certificates or letters of reference

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Signature

Clear
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Employment Application

Job Skills & Training

Employment Desired

Education history

Former Employment

References

Authorization