1 Start 2 Complete NAME EMAIL ADDRESS HOME PHONE ALTERNATE PHONE APPLYING FOR Full TIme Part Time Position Wanted Reception Technician Assistant Kennel Attendant Bather EDUCATIONAL BACKGROUND High School Graduated Yes No GED Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 College Graduated Yes No Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 QUALIFICATIONS/SKILLS WHAT RELATED EXPERIENCES COULD YOU CONTRIBUTE TO OUR PRACTICE? WORK HISTORY(Begin with most recent) Employer 1 Name of Supervisor From To Address Phone Duties Salary Reason For Leaving Hrs/Wk Employer 2 Name of Supervisor From To Address Phone Duties Salary Reason For Leaving Hrs/Wk Employer 3 Name of Supervisor From To Address Phone Duties Salary Reason For Leaving Hrs/Wk WHERE DID YOU HEAR ABOUT THIS POSITION? Newspaper Online newspaper Job search engine Employee Other REFERENCESReference 1 Full Name Home or Business Address Occupation Phone Number Reference 2 Full Name Home or Business Address Occupation Phone Number Reference 3 Full Name Home or Business Address Occupation Phone Number Please give us 5 attributes that you can consistently bring to our hospital that will make you indispensable. (each should be only 1 word) HAVE YOU EVER WORKED FOR A VETERINARIAN BEFORE? Yes No WOULD YOU HAVE ANY TRANSPORTATION PROBLEMS Yes No HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes No If yes, please explain HAVE YOU EVER BEEN DISCHARGED BY AN EMPLOYER? If so, give Employer Address Reason for Discharge DO YOU OWN ANY PETS? Yes No Please List 1 2 3 4 5 WHY DO YOU WANT TO WORK HERE? DO YOU HAVE ANY OBJECTIONS TO WORKING HOLIDAYS? Yes No If yes, please explain ARE YOU WILLING TO DO YOUR SHARE OF WEEKEND SHIFTS? Yes No ARE THERE ANY DAYS/HOURS YOU ARE UNABLE TO WORK? Yes No If yes, please explain This application does not constitute a written employment agreement.
