Employment Application

Full Name:*
Previous or Maiden Names:
Current Address:
Phone:*
Home Phone:
Email:*
Position(s) applied for: (check all that apply) Animal Care Attendant (Kennel)Veterinary AssistantNurseTechnicianReceptionist
Other position(s) applied for:
Do you have experience in an animal hospital? YesNo
Availability: Year-RoundPermanentSeasonalTemporary
Please describe availability limitiations:
Hours you are looking for: Part-time onlyFull-time onlyPart-time or full-time, as needed
If applying for part time only, how many hours do you want to work?
Hours you are routinely available to work:
What rate of pay do you expect?
Why do you want to work at an Animal Clinic?
What are your career goals for the next 2 years?
What are your career goals for the next 5 years?
In the past three years, have you ever knowingly used any narcotics, amphetamines or barbiturates, other than those prescribed to you by a physician? YesNo
If the answer is yes, furnish details.
Do you use illegal drugs? YesNo
Would you agree to and pass periodic routine drug tests? YesNo
Do you smoke? YesNo
Have you ever been terminated from a job because of stealing of other criminal conduct? YesNo
Please list all the pets you own:
Who is your current veterinarian?
Are all your pets up to date with all their routine recommended veterinary care? YesNo
Reference #1 Name:
Relationship:
Phone:
How long have they known you?
Reference #2 Name:
Relationship:
Phone:
How long have they known you?
Reference #3 Name:
Relationship:
Phone:
How long have they known you?

Previous Employer #1:
Start Date:
End Date:

Previous Employer #2:
Start Date:
End Date:

Previous Employer #3:
Start Date:
End Date: