Personal Information

Name *

Email *

Social Security Number *

Present Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Do you have a current Drivers License? *

Yes
No

Referred By *

Desired Employment

Position *

Date You Can Start *

Desired Salary *

Are You Currently Employed? *

Yes
No

If so, may we Inquire of Your Present Employer? *

Yes
No

Name, Address, and Phone Number of Present Employe *

Ever Applied at Parkview Animal Hospital Before? *

Yes
No

Are you looking for Full or Part-time work? *

Full-Time
Part-Time

Education History

High School

Years Attended *

Name & Location of School *

Did You Graduate?

Subjects Studied *

College

Years Attended *

Name & Location of School *

Did You Graduate?

Subjects Studied *

Trade, Business, or Correspondence School

Years Attended *

Name & Location of School *

Did You Graduate?

Subjects Studied *

List any Specific Skills, Training, or Knowledge that would assist you in this Industry

Former Employers (List Last Four Employers, Starting With Last One First)

Date Month and Year *

From

Date Month and Year *

To

Name & Address of Employer

Phone *

Salary *

Position *

Reason for Leaving *

Date Month and Year *

From

Date Month and Year *

To

Name & Address of Employer

Phone *

Salary *

Position *

Reason for Leaving *

Date Month and Year *

From

Date Month and Year *

To

Name & Address of Employer

Phone *

Salary *

Position *

Reason for Leaving *

Date Month and Year *

From

Date Month and Year *

To

Name & Address of Employer

Phone *

Salary *

Position *

Reason for Leaving *

References (Give the Names of Three Persons Not Related to You, Whom You Have Known at Least One Year)

Name *

Phone *

Address *

Business *

Years Known *

Name *

Phone *

Address *

Business *

Years Known *

Name *

Phone *

Address *

Business *

Years Known *

Have you ever been convicted of a felony? (This will not necessarily affect your application.)

Yes
No

If yes, please describe conditions. *

Attach additional information if necessary.

Click or drag a file to this area to upload.

AUTHORIZATION

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Parkview Animal Hospital from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of Parkview Animal Hospital has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) or other relevant federal and state laws.

Date *

Employment Application Form