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An Equal
Opportunity Employer
We do not discriminate on the basis of race,
religion. national origin, color, sex, age, veteran status, or
disability.
It is our intension that all qualified applicants be given equal
opportunity and that selection decisions are based on job-related
factors.
Personal
Social Security No.___________________________
Date_________________________
Name_______________________________________________________________________________ |
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Last |
First |
Middle |
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Present
address_____________________________________________Telephone
no.________________ |
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No.
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Street |
City |
State |
Zip |
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Position Applied for_______________________________Rate of pay
expected $_______per week |
Would you work______Full-time ______Part-Time Specify days and
hours if part-time________________ |
Were you previously employed by this organization?______ If yes,
when?___________________________ |
List any friends or relatives working here, other than spouse.
Names(s)_______________________________
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If your application is considered
favorably, on what date will you be available to work?___20__ |
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Are there any other work experiences,
skills, or qualifications that you feel would especially fit you for
work here? Please add any additional comments you think are
important for us to consider.__________ |
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__________________________________________________________________________ |
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__________________________________________________________________________ |
If you are applying for a job with
minimum age requirements, you may be required to
submit proof of age. For jobs with minimum age requirements:
Are you 18 years of age or
older?............................................................................q
yes
q
no |
For driving jobs only: Do you
have a valid driver's license?....................................q
yes
q no
Driver's license number________________________Class of licence_________________
Have you ever had your driver's license revoked for suspended in the
last 3 years?....q
yes
q no
If hired, can you furnish proof your are eligible to work in the
United States?
q yes
q no
Have you ever been convicted of a felony?.........................................................q
yes
q no
A "yes" answer does not automatically disqualify you
from employment since the nature of the offense, date, and the job
for which you are applying will be considered.
If yes, please
explain________________________________________________________
Have you previously applied here?.......................................................................q
yes
q no
If yes,
when?_____________________________________________________________Have
you worked for any firm under a different
name?...............................................q
yes
q no
If yes, give
name___________________________________________________________ |
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Personal References (not former employers or
relatives) Application continued-
page 2 of 3 |
| Name and occupation |
Address |
Phone number |
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Membership in Professional or Civic Organizations
(do not include racial, religious, or nationality groups) |
| Name
or description of organization |
Active participation |
Offices held |
| From |
To |
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Education Record-Non-veterinarians Only |
| Name of school |
Degree awarded |
Grade Average |
Honors |
High School |
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College or University |
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Business, Trade, Correspondence or Night School |
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Other |
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Do you type?
q
yes
q
Manual Machines___WPM
q no
q
Electric Machines____WPM |
Shorthand
____WPM
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Office machines and computers
you know how to operate |
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Education Record-Veterinarians Only |
| Name of school |
Degree awarded |
Grade Average |
Honors |
High School |
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College or University (Pre-veterinary) |
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College (Veterinary Curriculum) |
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Postgraduate training, including internships (include
dates and degrees awarded, if any)
__________________________________________________________________________
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| Are you board certified? q
Board eligible? q
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:_____________
____________________________________________________________________________ |
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Work History (begin with the most recent, list all past employers,
including
any pertinent military experience)
Application continued- page 3 of 3 |
Name of company
|
Business address
City
State |
Phone no. |
| Type of business |
Immediate supervisor |
Date employed
From To |
| Exact job title |
Earnings at hire |
At termination |
Reason for leaving
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Description of duties
__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
|
Name of company
|
Business address
City
State |
Phone no. |
| Type of business |
Immediate supervisor |
Date employed
From To |
| Exact job title |
Earnings at hire |
At termination |
Reason for leaving
|
|
|
Description of duties
__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
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Name of company
|
Business address
City
State |
Phone no. |
| Type of business |
Immediate supervisor |
Date employed
From To |
| Exact job title |
Earnings at hire |
At termination |
Reason for leaving
|
|
|
Description of duties
__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
|
Name of company
|
Business address
City
State |
Phone no. |
| Type of business |
Immediate supervisor |
Date employed
From To |
| Exact job title |
Earnings at hire |
At termination |
Reason for leaving
|
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Description of duties
__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
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Affidavit
I certify that all information I have
provided in this application is true and complete. I
understand that any false information or omission may
disqualify me from further consideration for employment and
may result in my dismissal if discovered at at 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, 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 a previously noted), 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 organization s
from any legal liability in making such statements. I
UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES
NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT
FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND
THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY
EMPLOYMENT MAY TERMINATED AT A Y TIME, WITH OR WITHOUT CAUSE
AND WITH OR WITHOUT NOTICE. I have read, understand, and
by my signature consent to there statements.
Signature
_____________________________________________________Date__________ |
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The Cat Doctor Veterinary Hospital and Hotel
9151 Ustick Rd., Boise ID
83704 |
