please Address

APPLICANT INFORMATION

Name *

First

Middle

Last

Date *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Date Available for Work *

Desired Salary($)

per hour

Position Applied for *

Type of Employment Desired *

Are you a citizen of the United States? *

Yes
No

Have you ever worked for this company? *

Yes
No

If so, when?

If you are under age 18? *

Yes
No

Have you ever been convicted of a felony? *

Yes
No

If yes, please explain.

*Answering yes to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation will be taken into consideration.

EDUCATION

High School

City/State

From

To

Did you graduate?

Yes
No

GED

GED

College

City/State

From

To

Did you graduate?

Yes
No

Degree

Degree

Other

City/State

From

To

Did you graduate?

Yes
No

Degree

Degree

Are you presently enrolled in school?

Yes
No

If Yes,

YOUR AVAILABILITY FOR WORK

Monday

Tuesday

Wednesday

Thursday

From

To

Friday

Saturday

Sunday

From

To

Our hours are as follows: Monday- Friday 7:45 a.m-5:30pm Saturdays 7:45am-1:00p

Total hours per week you expect to be available to work:

Do you have any special requests or needs for your work schedule? (be specific)

Are you willing/able to work your fair share of weekends and holidays?

Yes
No

If no, please explain

REFERENCES

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

PREVIOUS EMPLOYMENT

PROVIDE THE FOLLOWING INFORMATION OF YOUR PAST (3) EMPLOYERS, STARTING WITH MOST RECENT

Company

Phone

Address

Supervisor

Job Title

Starting Salary ($)

Ending Salary ($)

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No
Later

Company

Phone

Address

Supervisor

Job Title

Starting Salary ($)

Ending Salary ($)

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No
Later

Company

Phone

Address

Supervisor

Job Title

Starting Salary ($)

Ending Salary ($)

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No
Later

Veterinary Equipment: Are you capable of using any of these items?

OTHER SKILLS AND QUALIFICATIONS

Summarize any other work experience, training, certificates or licenses that you feel would be important for us to consider. If you wish, you may also include memberships in pet-related organizations or volunteer activities in which you regularly participate.

APPLICANT STATEMENT AND SIGNATURE

I certify that all information I have provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume’ or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations from furnishing such information about me.

I understand that the employer does not lawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration

Signature of Applicant *

Clear Signature

Date *

Employment Application Form

About This Form

Submit Your Application

APPLICANT INFORMATION

EDUCATION

If Yes,

YOUR AVAILABILITY FOR WORK

Our hours are as follows: Monday- Friday 7:45 a.m-5:30pm Saturdays 7:45am-1:00p

REFERENCES

PREVIOUS EMPLOYMENT

APPLICANT STATEMENT AND SIGNATURE

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