Employment Application Form

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Name:* This field is required.
First Name
Last Name
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Phone Number:* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
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Address:* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Other
Country
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Desired Position* This field is required.
Veterinary Technician
Registered/Certified Veterinary Technician
Client Relations (Reception)
Clinic Caretaker/Housekeeping
Pet Groomer
Pet Bather
Other
Administration/Management
Veterinarian
Technician Assistant
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Type of Employment* This field is required.
Full Time
Part Time
Temporary
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How many hours per week are you looking to work?Ex. 15-20
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MVVHC values the talents and varied interests that student employees bring and is dedicated to teaching and training those who wish to pursue a career in the veterinary health care field. Scheduling employees is challenging at best and while we are willing to work with student employees and their changing school schedules, we expect that student employees will be available to work additional days and hours during all holidays and school breaks, including Winter, Spring, and Summer breaks.* This field is required.
I understand and agree to the above statement
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When can you start?* This field is required.
Date
Year
Month
Day
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Expected Wage Per Hour* This field is required.
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Please list anyone you know who has worked or currently works for Mountain View Veterinary Health Center
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Are you available to be on call?* This field is required.Being on call entails being available after hours to treat/care for hospitalized animals and/or emergency cases. The days you are scheduled to be on call would require you to be within 20 minutes of our North Logan Hospital the entire time duration of your scheduled on call period.
YESNO
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Please list the times of day you are available to work.* This field is required.Be sure to include AM & PM. Scheduled shifts run from 6:00 AM to 9:00 PM Monday-Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Employment Status
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Are you currently employed?* This field is required.
YESNO
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Is your intent to continue in your current job if you are hired here?
YESNO
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Are you currently a student?* This field is required.
YESNO
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Please describe any commitments, activities, hobbies, vacation plans, etc. which may affect your ability to work here?:* This field is required.
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Employment History

Please list the most recent employer first. Include military service, or any self-employed periods
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Employer 1Most Recent Employer
Company Name
Phone Number
Start Date
End Date
Last Position Held
Last wage per hour
Why did you leave?
Please Select
Please Select
Yes
No
May we contact this employer?
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Employer 2
Company Name
Phone Number
Start Date
End Date
Last Position Held
Last wage per hour
Why did you leave?
Please Select
Please Select
Yes
No
May we contact this employer?
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Employer 3
Company Name
Phone Number
Start Date
End Date
Last Position Held
Last wage per hour
Why did you leave?
Please Select
Please Select
Yes
No
May we contact this employer?
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Employer 4
Company Name
Phone Number
Start Date
End Date
Last Position Held
Last wage per hour
Why did you leave?
Please Select
Please Select
Yes
No
May we contact this employer?
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Educational Background
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Please select the highest level of education you have completed* This field is required.
None
High School Diploma or GED
Associates or Technical Degree
Bachelors Degree
Masters Degree
Doctorate
Post Doctorate
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Please list any certifications, courses of study, or other pertinent education experiences.
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Other Information
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Driver's License Number and State of Issuance* This field is required.Type N/A if you do not have a Diver's License
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Are you at least 18 years of age?* This field is required.
YESNO
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Have you ever been known by a different name?* This field is required.
YESNO
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If yes, please list the name(s)
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Have you ever been convicted of a crime or violation other than a minor traffic violation in the last 7 years?* This field is required.
YESNO
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If yes, please describe
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Are you legally eligible to work in the United States of America?* This field is required.
YESNO
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What accommodation, if any, do you need to perform this work?
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Please write a brief paragraph describing what experience you have working with animals, and the reason you would like to work at this veterinary practice. You may also use this section to list anything else pertinent to your employment application.
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Are you able to comply with the following Conditions of Employment: * This field is required.JIMH, Inc dba Mountain View Veterinary Health Center sets a high standard for its employees. We require compliance with these standards as a condition of employment. You need to carefully consider what will be required before considering a position with us. As an employee of JIMH, Inc. dba Mountain View Veterinary Health Center you would be expected to comply in full. You need to know and understand that JIMH, Inc. dba Mountain View Veterinary Health Center will require you to: Meet performance standards of the position, Work hours as scheduled and report to work on time, Take direction from supervisors and execute that direction to the best of your ability, Maintain a positive, enthusiastic attitude at all times, Be a cooperative member of the Team, Undergo training, as needed, or requested, to maintain high standards and improve job performance, Maintain a business-like, professional appearance at all times.
YESNO
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If no, please explain
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Acknowledgements & Agreements* This field is required.Please read the following and address any questions or concerns to our HR representatives before submitting your application: A consumer report and/or investigative consumer report including information concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode of living and/or credit and indebtedness may be obtained in connection with your application for and/or continued employment with the employer. A drug screening test may also be obtained by the employer. A consumer report, drug screening and/or an investigative consumer report may be obtained at any time during the application process or during your employment with the employer. A consumer report containing injury and illness records and medical information may be obtained after a tentative offer of employment has been made. Upon timely written request of the personnel department of the employer, and within 5 days of the request, the name, address, and phone number of the reporting agency and the nature and scope of the investigative consumer report will be disclosed to you. Before any adverse action is taken, based in whole or in part on the information contained in the consumer report, you will be provided a copy of the report, the name, address and telephone number of the reporting agency, and a summary of your rights under the Fair Credit Reporting Act. You hereby authorize all personnel, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any and all information pertinent to your employment and release the same from any liability resulting from providing such information. JIMH, Inc. dba Mountain View Veterinary Health Center has your permission to make said inquiries and you hereby release JIMH, Inc. dba Mountain View Veterinary Health Center from any liability in making said request or in relying on the information received.You understand that satisfactory reports are a condition of your employment with JIMH, Inc. dba Mountain View Veterinary Health Center. You further understand that your employment with JIMH, Inc. dba Mountain View Veterinary Health Center will be terminated if management determines that said reports are unsatisfactory.You also acknowledge that from time to time, JIMH, Inc. dba Mountain View Veterinary Health Center may be required to submit certain information with regard to your employment or application for employment. You hereby release JIMH, Inc. dba Mountain View Veterinary Health Center, its agents, assigns and subsidiaries from any liability from submitting such information. You acknowledge that JIMH, Inc. dba Mountain View Veterinary Health Center may request either prior to and/or after employment that you undergo drug testing and may request after an offer has been made, a medical exam. You consent and agree to any such exam, if required, now or in the future. You understand when pre-employment drug testing is required, a satisfactory result is a condition of employment with JIMH, Inc. dba Mountain View Veterinary Health Center. You hereby certify that all statements and answers made on this Employment Application are complete and true. You understand that if subsequent to employment any of such statements and/or answers is found to be false or that information is omitted, such false statements or omissions will be considered grounds for termination of your employment. Federal law requires supervisors/employers to review documents verifying your identity and eligibility to work in the United States and to complete Form I-9 (Employment Eligibility Verification). You will be required to provide this documentation.Supervisors/employers are in violation of the law if the documents are not reviewed and Form I-9 is not completed. Your completed application will be used to determine your eligibility for the position for which you are applying
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