Job Application

EMPLOYMENT APPLICATION
Elgin Animal Clinic is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should any applicant need reasonable accommodation in the application process, he or she should contact a company representative.
Please fill out all the sections below:
Applicant Information
Full Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Email Address*
(myname@example.com)
Social Security Number*
(xxxxxxxxx)
Employment Position
Position applying for:*
Position Type*
Days Available to Work*

MondayWednesdayFridaySundayTuesdayThursdaySaturday
Hours Available to Work*
Date available to start?*

MonthDayYear
Do you own any animals?

YesNo
Do you have any professional experience with animals besides being a pet owner?

YesNo
If yes, please briefly explain
Personal Information
Have you ever applied to or worked for Elgin Animal Clinic before?*

YesNo
If yes, when?*
Do you have any friends, relatives, or acquaintances working for Elgin Animal Clinic?*

YesNo
If yes, state name & relationship:*
Are you 18 years of age or older?*

YesNo
If you are under 18 years of age, can you provide a work permit?*

YesNo
If no, explain:*
Are you a U.S. citizen or approved to work in the United States?*

YesNo
Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

YesNo
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:*
(Note: No applicant will be denied employment solely on the ground of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
Job Skills & Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying:*
Education & Training
High School
School Name:*
Location (City, State)*
Year Graduated*
Degree Earned*
College/University
School Name:*
Location (City, State)*
Year Graduated*
Degree Earned*
Vocational School/Specialized Training
School Name:*
Location (City, State)*
Year Graduated*
Degree Earned*
Military
Are you member of the U.S Armed Forces?*

YesNo
If yes, which branch did you serve in and how many years did you serve?*
What military skills do you possess that would be an asset to this company?*
Previous Employment
1.

(write "n/a" in all fields if they do not apply)
Company Name*
Address*
(Street, City, State, Zip)
Phone Number*
(xxx) xxx-xxxx
Supervisor Name*
Supervisor Title*
Dates of Employment*
(mm/yyyy to mm/yyyy)
Position(s) Held*
Responsibilities*
Starting Salary and Title*
Ending Salary and Title*
Reason for Leaving*
May we contact this employer for a reference?*

YesNo
2.

(write "n/a" in all fields if they do not apply)
Company Name*
Address*
(Street, City, State, Zip)
Phone Number*
(xxx) xxx-xxxx
Supervisor Name*
Supervisor Title*
Dates of Employment*
(mm/yyyy to mm/yyyy)
Position(s) Held*
Responsibilities*
Starting Salary and Title*
Ending Salary and Title*
Reason for Leaving*
May we contact this employer for a reference?*

YesNo
3.

(write "n/a" in all fields if they do not apply)
Company Name*
Address*
(Street, City, State, Zip)
Phone Number*
(xxx) xxx-xxxx
Supervisor Name*
Supervisor Title*
Dates of Employment*
(mm/yyyy to mm/yyyy)
Position(s) Held*
Responsibilities*
Starting Salary and Title*
Ending Salary and Title*
Reason for Leaving*
May we contact this employer for a reference?*

YesNo
References
1.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
How do you know this person?*
How long have you known this person?*
2.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
How do you know this person?*
How long have you known this person?*
3.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
How do you know this person?*
How long have you known this person?*

Upload a Resume & Cover Letter
Resume*

Upload a File

Cancelof
Cover Letter

Upload a File

Cancelof
Any additional comments?
At-Will Employment
The relationship between you and the Elgin Animal Clinic is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Elgin Animal Clinic. No representative of the Elgin Animal Clinic has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or weitten statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and our Company's President.
I have read and agree to the "At- Will" employment section*

I accept
Applicant Signature*

Clear
(Use mouse/finger to sign your name on the line)
Today's Date*

MonthDayYear
Google reCAPTCHA*
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EMPLOYMENT APPLICATION