PAW PRINTS ANIMAL HOSPITAL
EMPLOYMENT APPLICATION

Name

First Last

Social Security Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

The position that I am applying for is:

I am applying for the position of:

For part-time or relief please indicate the hours per week (or month) desired:

I have the following experience and skills that qualify me for this position:

I am available to start work:

My desired salary:

How would past and present co-workers describe you?

Have you ever been fired from a job?

Yes
No

If “yes”, please explain in detail:

Have you ever resigned after learning that you might be fired?

Yes
No

If “yes”, please explain in detail:

Have you ever been convicted of a misdemeanor or felony, or been given a suspended imposition of sentence?

Yes
No

If “yes,” please explain in detail: a) the date(s) of the convictions or suspended imposition of sentence, b) the type of crime as it was initially charged, c) if it was amended, the type of crime after it was amended, d) the sentence (including probation), and e) the name and location of the court(s).

Social Media Name(s):

Will you provide us with access to view your social media posts and history?

Yes
No

Prior Employment (include three most recent employers)

1. Employer:

Job Title:

Dates Employed:

Phone:

Supervisor:

Pay Rate/Salary:

Reason for Leaving:

2. Employer:

Job Title:

Dates Employed:

Phone:

Supervisor:

Pay Rate/Salary:

Reason for Leaving:

3. Employer:

Job Title:

Dates Employed:

Phone:

Supervisor:

Pay Rate/Salary:

Reason for Leaving:

Education (School/Degree Received/ Honors Received):

Licenses and Certifications (Include State and Date Received):

Have any licenses or certifications been suspended, revoked, or placed on probation? If “yes,” provide all details, dates and copies of the complaint(s) and suspension or revocation or probation order:

Has a disciplinary complaint ever been filed against you with any state licensing agency? If “yes,” provide all details, dates and copies of the complaint(s) and suspension or revocation order:

Professional References (Please list three):

1. Name:

Company:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:

Email:

Relationship:

2. Name:

Company:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:

Email:

Relationship:

3. Name:

Company:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:

Email:

Relationship:

Have you ever been required to register as a sexual or violent offender? If “yes”, please explain in detail, including the offense(s) that resulted in the registration, and the state(s) in which you were required to register.

May we contact your current employer? If “yes,” provide the name, job title, email address and telephone number of the person to contact.

Are you able to perform the essential functions of the job that you are applying for, either with our without a reasonable accommodation?

Do you agree to submit to drug or alcohol screening tests including urinalysis, blood tests, and breathalyzers?

Have you ever served in the military? If “yes,” please provide the branch, dates of service, your rank at discharge, and the type of discharge. If other than honorable discharge, please provide details.

ALL OF THE INFORMATION IN THIS APPLICATION FORM IS TRUE AND COMPLETE. I HAVE NOT OMITTED ANY INFORMATION. I UNDERSTAND THAT ANY OMISSION OR MISREPRESENTATION THAT IS DISCOVERED AT A LATER DATE WILL DISQUALIFY ME FOR EMPLOYMENT AND, IF I AM HIRED, WILL RESULT IN MY DISMISSAL.

I AUTHORIZE ALL OF MY FORMER EMPLOYERS, AND ALL INDIVIDUALS EMPLOYED BY MY FORMER EMPLOYERS, TO PROVIDE A COPY OF MY EMPLOYMENT FILE AND EMPLOYMENT RECORDS, AND TO DISCUSS IN DETAIL ALL INFORMATION REGARGING MY PAST EMPLOYMENT, INCLUDING MY JOB PERFORMANCE, THE REASON(S) THAT MY EMPLOYMENT ENDED, AND MY SKILLS. I RELEASE MY FORMER EMPLOYERS AND THEIR EMPLOYEES FROM ALL CLAIMS AND LIABILITY FOR STATEMENTS MADE IN RESPONSE TO REFERENCE REQUESTS.

I UNDERSTAND THAT, IF I AM HIRED: (a) EITHER THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME; AND (b) I MAY BE ASKED TO SIGN AN AGREEMENT PROTECTING THE COMPANY’S CONFIDENTIAL INFORMATION AND/OR PROHIBITING ME FROM COMPETING WITH THE COMPANY AFTER MY EMPLOYMENT ENDS.

Name:

First Last

Date:

Upload Resume

Authorization To Release Information

I,

authorize any and all of my former employers to provide Paw Prints Animal Hospital my employment records and employment file, and any information and documents describing: (a) my job duties, (b) the reason(s) I left that employment, and (c) any aspect of my employment including the quality of my job performance. I release my former employers and their agents, officers and employees from any and all claims, damages and liabilities arising from or in any way connected with the disclosure of the information and documents to [Paw Prints Animal Hospital]

Signature

Name:

First Last

Date:

Careers

WE ARE HIRING!

Positions Available:

PAW PRINTS ANIMAL HOSPITAL
EMPLOYMENT APPLICATION

Prior Employment (include three most recent employers)

Professional References (Please list three):

Authorization To Release Information

WE ARE HIRING!

Positions Available:

PAW PRINTS ANIMAL HOSPITAL EMPLOYMENT APPLICATION

Prior Employment (include three most recent employers)

Professional References (Please list three):

Authorization To Release Information

PAW PRINTS ANIMAL HOSPITAL
EMPLOYMENT APPLICATION