Gibson Veterinary Clinic Employment Application

Gibson Veterinary Clinic Employment Application

Please fill out the form completely and clearly. Applicants may be tested for illegal drugs. We are an equal opportunity employer and do not discriminate on any basis protected by law. Gibson Veterinary Clinic (GVC) will provide reasonable accommodation as required by the ADA and applicable laws.
Applicant Information
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name

First NameMiddle NameLast Name
Identification Number
Email Address
example@example.com
Have you ever been employed or enrolled in school under another name?
Other Name Used
Present Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Permanent Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Are you 18 years of age or older?
Are you 16 years of age or older?
How did you hear about Gibson Veterinary Clinic?
Position Details
Position Applied For
Employment Desired
Hours Desired per Week or Month
Date Range of Availability

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Can you perform the essential functions of the job with or without accommodation?
Available Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Wage Desired
Are you currently employed?
May we contact your present employer?
Have you ever applied with Gibson Veterinary Clinic before?
Are you able to work overtime?
Are you legally eligible for employment in the USA?
Have you ever pled guilty or no contest to, or been convicted of, a felony?
Have you been convicted of a misdemeanor in the last seven years?
If yes to either criminal history question, please explain
Are you able to provide a valid driver's license if necessary for the job?
Availability
GVC is open Monday-Friday 8am-5pm and Saturday 8am-12pm.
Sunday - Available From

Hour Minutes

AM/PM Option
Sunday - Available To

Hour Minutes

AM/PM Option
Monday - Available From

Hour Minutes

AM/PM Option
Monday - Available To

Hour Minutes

AM/PM Option
Tuesday - Available From

Hour Minutes

AM/PM Option
Tuesday - Available To

Hour Minutes

AM/PM Option
Professional Qualifications
Professional licenses, certifications, or registrations
Additional skills and competencies
Veterinary software used
Education
High School Name
High School Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Diploma Received
College/University Name
College/University Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Degree Received
Other School Name
Other School Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Other Degree Received
Professional References
Please list 3 professional references you have known for at least 1 year. Do not include relatives.
Reference 1 Name

First NameMiddle NameLast Name
Reference 1 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Company
Reference 1 Position
Reference 1 Years Known
Reference 1 Email
example@example.com
Reference 2 Name

First NameMiddle NameLast Name
Reference 2 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Company
Reference 2 Position
Reference 2 Years Known
Reference 2 Email
example@example.com
Reference 3 Name

First NameMiddle NameLast Name
Reference 3 Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Company
Reference 3 Position
Reference 3 Years Known
Reference 3 Email
example@example.com
Employment History
List employers starting with the most recent first. Include related volunteer or non-paid experience. Please complete even if you attach a resume.
Employer Name
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
May we contact for a reference?
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Job Title
Supervisor’s Name

First NameMiddle NameLast Name
Supervisor’s Title
Supervisor’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reason for Leaving
Starting Wage
Final Wage
Description of Jobs Held, Duties Performed, Skills Used or Learned, Advancements or Promotions
Employer Name
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
May we contact for a reference?
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Job Title
Supervisor’s Name

First NameMiddle NameLast Name
Supervisor’s Title
Supervisor’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reason for Leaving
Starting Salary
Final Salary
Description of Jobs Held, Duties Performed, Skills Used or Learned, Advancements or Promotions
Employer Name
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
May we contact for a reference?
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Job Title
Supervisor’s Name

First NameMiddle NameLast Name
Supervisor’s Title
Supervisor’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reason for Leaving
Starting Wage
Final Wage
Description of Jobs Held, Duties Performed, Skills Used or Learned, Advancements or Promotions
Written Questions
Why do you want to work for Gibson Veterinary Clinic?
Describe a specific situation where you provided excellent customer service in your most recent position, and explain why it was effective.
Final Certification
Did you complete this application yourself?
If no, who completed the application for you?
May we share your application and resume with another local veterinary hospital if no suitable position is currently open?
Applicant certification and acknowledgment
Applicant signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Gibson Veterinary Clinic Employment Application

Applicant Information

Position Details

Availability

Professional Qualifications

Education

Professional References

Employment History

Written Questions

Final Certification