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ONLINE APPLICATION

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

POSITION

Position(s) Applied For:

Date of Application:

(ex: Month/Day/Year)

How Did You Learn About Us?

Other:


PERSONAL INFORMATION

First Name:

Last Name:

Middle Name:

Street Address:

City :

State:

Zip Code:

Telephone Number:

Email:

Date of Birth: (ex: Month/Day/Year)

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

Yes:

No:

(Proof of citizenship or immigration status will be required upon employment.)

On what date would you be available for work?

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

Are you a permanent County Resident:

Yes:

No:

If no, how long do you plan to remain in this area?

Have you ever been employed with us before?

Yes:

No:

If Yes, give relevant dates: (ex: Month/Day/Year)

to

Have you been convicted of a felony within the last 7 years?

Yes:

No:

Conviction will not necessarily disqualify an applicant from employment. If Yes, please explain:


EMPLOYMENT HISTORY

Are you currently employed?

Yes:

No:

May we contact your present employer?

Yes:

No:

Expected Salary:


Employer 1:

Street Address:

City:

State:

Zip Code:

Telephone Number:

From:

to

Position:

Supervisor:

Salary:

Work Experience:

Reason for leaving or wishing to leave most recent employer:


Employer 2:

Street Address:

City:

State:

Zip Code:

Telephone Number:

From:

to

Position:

Supervisor:

Salary:

Work Experience:

Reason for leaving or wishing to leave most recent employer:


Employer 3:

Street Address:

City:

State:

Zip Code:

Telephone Number:

From:

to

Position:

Supervisor:

Salary:

Work Experience:

Reason for leaving or wishing to leave most recent employer:

Please List Any Animal Handling Experience:

State any additional information you feel may be helpful to us in considering your application:

EDUCATION

High School:

Name and Address of school:

Course of Study:

Years Completed:

Diploma/Degree:


Undergraduate
College:

Name and Address of school:

Course of Study:

Years Completed:

Diploma/Degree:


Other:

Name and Address of school:

Course of Study:

Years Completed:

Diploma/Degree:

REFERENCES

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone Number:


First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone Number:


First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone Number:


APPLICANT'S STATEMENT:
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Please confirm : and Initial



Mid-Atlantic Animal Specialty Hospital

Referral Veterinary Surgery

2007