Application for Employment

An Equal Opportunity Employer
We do not discriminate on the basis of race, religion, national origin, color, sex, age, veteran status or disability: It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.
* All form fields with an "*" must be filled in order to successfully submit the form.

Client Information

*Last Name:
*First Name:
*Address:
*City:
*State:
*Zip Code:
*Telephone:
*Email Address:
*Position Applied For:
*Rate of Pay Expected:
$ per week
Would you work:
Full-time
Part-time
Specify Days and hours if part-time:


Have you ever been employed by Otterkill Animal Hospital?
Yes   If yes, when:
No


List any friends or relatives employed by Otterkill Animal Hospital, other than spouse :


*If your application is considered favorably, what date would you be available for work?:

Are there work experiences, skills, or qualifications that you feel make you especially qualified for this position? Please add any additional comments you think are important for us to consider.

If you are applying for a job with minimum age requirements, you may be required to submit proof of age.

Are you 18 years of age or older?
Yes    No


For driving jobs only,
Do you have a valid driver's license?
Yes    No
Driver's License number: Class of license:
Have you had your driver's license revoked or suspended in the last 3 years?
Yes    No


If hired, can you furnish proof you are eligible to work in the United States?
Yes    No


*Have you ever been convicted of a felony?
Yes    No

A "yes" answer does not automatically disqualify you from employment since the nature of offence, date, and the job which you are applying for will be considered. If yes, explain:

Have you ever been employed under a different name?
Yes    No
If yes, please give name(s):


Personal References (not former employers or relatives)

Name & Occupation Address Phone Number


Membership in Professional or Civic Organizations (do not include racial, religious, or nationality groups)

Name of Organization Time of Participation Offices Held

Education Record, Non-veterinarians Only

Name of School Degree Grade Average Honors
* High School
* * *
College/University
Business/Trade/Night School
Other

How many words a minute can you type?

Are there work experiences, skills, or qualifications that you feel make you especially qualified for this position? Please add any additional comments you think are important for us to consider.

Education Record, Veterinarians Only

Name of School Degree Grade Average Honors
High School
College/University - Pre-Vet
College/University - Pre-Vet

Postgraduate training, including internships (include dates and degrees awarded, if any)

Are you board certified?
Yes    No

Board eligible?
Yes    No
Which Board

List continuing education courses attended in the past 18 months:


List the states in which you are licensed to practice along with license number:

Work History (begin with the most recent, list all past employers, including any pertinent military experience)

* Name of Company
* Business Address
* Phone
* Type of Business
* Immediate Supervisor
* Dates Employed
* Exact Job Title
* Starting & Ending Salary
* Reason for Termination

Description of duties:


Name of Company
Business Address
Phone
Type of Business
Immediate Supervisor
Dates Employed
Exact Job Title
Starting & Ending Salary
Reason for Termination

Description of duties:


Name of Company
Business Address
Phone
Type of Business
Immediate Supervisor
Dates Employed
Exact Job Title
Starting & Ending Salary
Reason for Termination

Description of duties:



Affidavit

I certify that all the 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 dismissal if discovered at a later date. I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from neighbors, friends, former employers, schools, and others. I understand I have the right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except previously noted), past employers and organization named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organization from any legal liability making such statements.

* I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the Employer and my employment may be terminated at any time, with or without cause or without notice.
I have read, understand, and by my signature consent to these statements.


* All form fields with an "*" must be filled in order to successfully submit the form.

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