Application For Employment

Application For Employment

Stone Cottage Veterinary Hospital
Date of Application:*

MonthDayYear
Date
Date Available to Work:

MonthDayYear
Date
Position of Interest: *
Full Time or Part Time?*

Full TimePart Time
If part time, what range of hours:
Are you willing/able to work weekends and holidays if requested?*

YesNo
If no, please explain:
If you are a student, are you available during any prolonged school break (i.e. summer, fall, winter)?

YesNot
Are you age 16 or older?*

YesNo
Would you be willing to consent to pre-employment or randomized drug testing during employment?*

YesNo

Your Availability for Work:

	Monday	Thuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Time (From-to)

How were you referred?
Desired Wage:
Personal Information:
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Emergency Contact Information (Name and Phone Number):
Have you ever been convicted, forfeited bond, or are currently on probation for any felony, or any equal offense under the penalty of law?*

YesNo
Are you authorized to work in the U.S. on an unrestricted basis?*

YesNo
Can you perform essential functions of this job (i.e. lifting greater than 40lb) without reasonable accommodations?*

YesNo
Qualifications:

Please list any education or training you feel relates to the position applied for that would help you perform the work such as schools, colleges, technical programs, veterinary specific programs, etc.:*

	SCHOOL	DATES	MAJOR	DEGREE
.
.
.

OTHER:
Special Skills:
List any special skills or experiences that you feel will help you regarding the position you are applying for. Also include professional organizations you are a member of:
References:

Please list 3 professional references not related to you, with full name, phone number, address and relationship.*

	NAME	ADDRESS/CITY/ STATE	PHONE	RELATIONSHIP
1
2
3

Work History:

Start with your present or most recent employment and work backward.
Job TITLE* Start Date* End Date* Company Name* Supervisor City* State* Zip* Duties* Reason for Leaving* Ending Wage*
May we contact your present employer?*

YesNo
Job TITLE Start Date End Date Company Name Supervisor City State Zip Duties Reason for Leaving Ending Wage
Job TITLE Start Date End Date Company Name Supervisor City State Zip Duties Reason for Leaving Ending Wage
I certify that these facts set forth in the Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions, or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The Employer may contact any listed reference on this application.

I acknowledge and understand that this company is an “at-will " employer and that employment, if offered, may be terminated at any time.
Applicant Signature*

Clear
Should be Empty:

Personal Information:

Qualifications:

Special Skills:

References:

Work History: