Employment Application

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Job Applied For:

Receptionist

CVT

Assistant

Other…

How did you learn about this position?

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Employee Referral

Friend

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Voluntary Information

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Affirmative Action

If you choose to provide this information, it will help us evaluate the effectiveness of our affirmative action programs. This will also be used for research and statistical purposes. Ethnic Background (check only one)

Asian or Pacific Islander:

Persons having origins in any of the peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.

African American (not of Hispanic origin):

Persons having origins in any of the black ethnic groups.

Hispanic

Persons having origins in any of the Mexican, Puerto Rican, Cuban, Central or South American or other Spanish cultures, regardless of ethnicity.

Native American or Alaskan Native:

Persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

Caucasian (not of Hispanic origin):

Persons having origins in any of the original peoples of Europe, North Africa or the Middle East.

Gender

Male

Female

Disabled

Yes

(Checking the "Yes" box has no effect on an employer's obligation to provide reasonable accommodation under state and federal disability laws.)

Job Applied For

State of Issue

Personal Information

First

Last

Email Address:

Address

City/Town

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Referred by:

Home Telephone (Include Area Code):

Work Telephone (Provide only one Including area code):

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Present Employer

Last Employer

May we contact

Yes

City and State

Work Schedule Availability

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Permanent

Seasonal

Either

Check only one

Full Time

Part Time

Full or Part Time

Intermittent

Any

Date you can report for work

Employee History

The DEA requires us to ask these questions of every applicant.

Within the past five years, have you been convicted of a felony, or within the past two years, of any misdemeanor or are you presently formally charged with committing any criminal offense? (Do not include any traffic violations, juvenile offenses or military convictions, except by general court martial.) If the answer is yes, furnish details of conviction, offense, location, date and sentence.

Yes

In the past three years, have you ever knowingly used any narcotics, amphetamines or barbiturates, other than those prescribed to you by a physician? If the answer is yes, furnish details

Yes

Details:

Education / Training History

List colleges, military, trade, business or other schools attended.

Do you have a high school diploma or a GED certificate?

(Check one)

Yes

Name and Location Of School, College, or University:

Course of Study (List Major)

Credits Earned

Did You Graduate?

Yes

Degree or Certificate Received

Add another school?

Yes

Name and location of school:

Did you graduate?

Credits Earned

License / Registration / Certificate

List any required professional license, registration, certificate, Commercial Driver’s License (CDL), etc.

Description

State

Number

Expiration

Specialized Skills and Knowledge

List skills or knowledge that show your ability to perform the job for which you are applying (such as typing speed, computer languages or software programs, foreign languages, etc.). Attach additional pages as needed.

Work History

Job Number 1 (current or most recent position)

Name of Employer:

Kind of Business:

Your Job Title:

From and To (Month to Year)

Hours worked per week (average)

Total time in current or last position:

Employer's Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Employer Phone:

Supervisor's Name and Phone Number:

Supervision / Leadwork Check Areas You Were Responsible For:

Assigning and Reviewing work

Rating Work Performance

Hiring or Recommending Hiring

Handling Disciplinary problems

Responding to Grievances

Not Responsible for Any of Above

If you checked any of these boxes, list the number of employees and their job titles:

Duties (List all duties you performed. No credit will be given if this section is not completed.):

Position

Reason for leaving this position

Add another employer? (Job number 2)

Yes

Select if you wish to add another reference

Name of Employer:

Kind of Business:

Your Job Title:

From and To (Month to Year)

Hours worked per week (average)

Total time in current or last position:

Employer's Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Employer Phone:

Supervisor's Name and Phone Number:

Supervision / Leadwork Check Areas You Were Responsible For:

Assigning and Reviewing work

Rating Work Performance

Hiring or Recommending Hiring

Handling Disciplinary problems

Responding to Grievances

Not Responsible for Any of Above

If you checked any of these boxes, list the number of employees and their job titles:

Duties (List all duties you performed. No credit will be given if this section is not completed.):

Reason for leaving this position

Enter reason for leaving

Add another employer? (Job number 3)

Yes

Select if you wish to add another reference

Name of Employer:

Kind of Business:

Your Job Title:

From and To (Month to Year)

Hours worked per week (average)

Total time in current or last position:

Employer's Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Employer Phone:

Supervisor's Name and Phone Number:

Supervision / Leadwork Check Areas You Were Responsible For:

Assigning and Reviewing work

Rating Work Performance

Hiring or Recommending Hiring

Handling Disciplinary problems

Responding to Grievances

Not Responsible for Any of Above

If you checked any of these boxes, list the number of employees and their job titles:

Duties (List all duties you performed. No credit will be given if this section is not completed.):

Reason for leaving this position

Add another employer? (Job number 4)

Yes

Name of Employer:

Kind of Business:

Your Job Title:

From and To (Month to Year)

Hours worked per week (average)

Total time in current or last position:

Employer's Address:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Employer Phone:

Supervisor's Name and Phone Number:

Supervision / Leadwork Check Areas You Were Responsible For:

Assigning and Reviewing work

Rating Work Performance

Hiring or Recommending Hiring

Handling Disciplinary problems

Responding to Grievances

Not Responsible for Any of Above

If you checked any of these boxes, list the number of employees and their job titles:

Duties (List all duties you performed. No credit will be given if this section is not completed.):

Reason for leaving this position

Certification and signature

I understand that any verbal or written statement that is false, fraudulent or misleading that is contained in this application or attached materials, or made in the course of any related employment process, whether made by me or by others at my request, will result in rejection of my application, denial of employment, or dismissal from service if discovered after employment, and under some circumstances, may result in prosecution for a crime.

I certify that all statements contained herein are true and complete.
I understand that if hired, I must prove that I am legally authorized to work in the United States.
I authorize All Creatures Veterinary Care Center to check employment references and verify education information provided on this employment application and as disclosed in the interview process.
I authorize All Creatures Veterinary Care Center to check my driving record if the position for which I am applying requires driving.
I authorize 2 nd Street Animal Hospital to run a credit history check and criminal history backgroundcheck as a condition of employment.
I release the All Creatures Veterinary Care Center and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process.

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Employment Application

Please Complete The Following Information

Work Schedule Availability

Employee History

License / Registration / Certificate

Certification and signature

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