Programs, services and employment are available equally to everyone. Please inform the Office Manager if you require accommodations for the application or interview.
Position applying for:
Date:
How were you referred to us:
Full Name (Last, First Mi:)
Street Address:
City:
State:
ZIP:
Phone:
ALT Phone:
Email:
Date available to start:
Expected Wage:
If you are under the age of 18 and we require a work permit can you furnish one:
If no, please explain:
Have you ever worked for Tri-County Veterinary Hospital in the past:
If yes when:
Are you a citizen of the United States:
If not, are you authorized to work in the United States:
Type of employment desired:
Have you ever plead "guilty" or "no contest" to or been convicted of a crime:
If yes, please explain:
Answering yes to these questions does not constitute an automatic rejection to employment. Date of offense, seriousness and nature of the violation, rehabilitation and position applied for will all be considered:
Education
EXP Date:
State:
Driver's license number:
High School:
Address:
# of years completed:
Did you graduate:
Degree:
Major:
GPA:
Class Rank:
College:
Address:
# of years completed:
Did you graduate:
Degree:
Major:
GPA:
Class Rank:
Other:
Address:
# of years completed:
Did you graduate:
Degree:
Major:
GPA:
Class Rank:
Reference
Please furnish the names, addresses and telephone numbers of two people to whom you are not related and by whom you have not been employed.
Name:
Phone:
Street Address:
City:
State:
ZIP:
Name:
Phone:
Street Address:
City:
State:
ZIP:
Summarize your Special Skills and/or Qualifications:
Previous Employment
Dates of Employment: From
To
Position Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer:
Dates of Employment: From
To
Position Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer:
Dates of Employment: From
To
Position Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer:
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial,, or medical and other related matters as may be necessary for an employment decision. I hereby release employers, school, or persons from all liability in responding to inquiries in connection with my application.
In the event I am employed, I understand that false misleading information given in my application or interview(s) may result in discharge.
Applicant must be able to work 12 hour shifts + emergency hours if needed.
