HomeResourcesFormsEmployment Application Employment Application AN EQUAL OPPORTUNITY EMPLOYER We do not discriminate on the basis of any federal or state identified protected status, such as race, religion, national origin, color, sex, age, veteran status, disability or sexual preference. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.PERSONALSocial Security No Date Name* First Middle Last Present Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneEmail* Position Applied For Desired Rate Available to Work Full Time Part Time Specify Days & Hours, If Part Time Were you previously employed by this organization? If Yes, When Did anyone refer you to apply here?* Yes No If yes, who?* If your application is considered, on what date will you be available for work? Are there any other work experiences, skills, or qualifications that you feel would especially fit you for work here? If you are applying for a job with minimum age requirements, you may be required to submit proof of age. 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 If Yes, Explain Have you previously applied here? YES NO If Yes, When? Have you worked for any employer under a different name? YES NO If Yes, Give Name Each of the following sections needs to be completed. A resume does not substitute for completing these sections. PERSONAL REFERENCES (Not Former Employers or Relatives)Name Address Years Known Phone Number Name and Occupation Address Years Known Phone Number Name and Occupation Address Years Known Phone Number Name and Occupation Address Years Known Phone Number MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS(Do not include, racial, religious, or nationality groups) Name or description of organization Active Participation (From/To) Offices Held Name or description of organization Active Participation (From/To) Offices Held Name or description of organization Active Participation (From/To) Offices Held EDUCATIONAL RECORD Non Veterinarians OnlyHigh school Degree/Graduated Y or N Grade Ave College or University Degree/Graduated Y or N Grade Ave Other Business Trade, Correspondence or Night School Degree/Graduated Y or N Grade Ave Veterinary Technician Licensing Program Degree/Graduated Y or N Grade Ave Can you use a computer keyboard to enter and retrieve data? YES NO Other office machines you know how to operate If experienced with veterinary software programs, please list those with which you have worked EDUCATIONAL RECORD Veterinarians Only High School Degree/Graduated Y or N Grade Ave Honors College or University (Preveterinary) Degree/Graduated Y or N Grade Ave Honors College (Veterinary Curriculum) Degree/Graduated Y or N Grade Ave Honors Post training, including internships (include dates and degrees awarded, if any) Are You Board Certified? Board Eligible? Which Specialty Board? List continuing education courses attended in the past 18 months List the states in which you are licensed to practice along with license numbers WORK HISTORY Begin with the most recent. List all past employers including any pertinent military experiences. Explain any time gaps, a resume does not substitute for completing this section.Name of Company Business Address Phone Type of Business Immediate Supervisor Dates Employed Exact Job Title Reason for Termination Description of dutiesName of Company Business Address Phone Type of Business Immediate Supervisor Dates Employed Exact Job Title Reason for Termination Description of dutiesName of Company Business Address Phone Type of Business Immediate Supervisor Dates Employed Exact Job Title Reason for Termination Description of dutiesRESUMEPlease attach your resume belowAccepted file types: doc, docx, pdf, odt, rtf, Max. file size: 256 MB.AFFIDAVITI CERTIFY that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me form further consideration 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 and former employers, schools and others. I understand I have a 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 as previously note), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making any statement. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEES EMPLOYMET FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I MAY HAVE BEEN HIRED AT TEH WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I have read, understand, and by my signature consent to these statements. Affidavit:* I agree/consentSignature* Date*
