APPLICATION FOR EMPLOYMENT (PLEASE PRINT)



APPLICATION FOR EMPLOYMENT (PLEASE PRINT)

We appreciate your interest in employment with Westwood Animal Hospital. We are very interested in your qualifications and abilities. An understanding of your background and work history is necessary for us to properly place you in an available position. State and/or federal laws prohibit discrimination on the basis of age or gender. This information is requested for reporting purposes only.

Please fill out this form completely.

PERSONAL INFORMATION Today’s Date: ___________________

Name: _____________________________________ Gender: _________________

LAST FIRST MIDDLE INITIAL

E-mail address: ________________________________________________________

Daytime phone #: ____________________ Evening phone #: ____________________

Date of Birth: ______________ Are you authorized to work in the U.S.?: YES / NO

Home Address: _________________________________________________________

City: ___________________________ State:_________ Zip Code: ________________

Position applying for: _______________________ Expected pay rate: $________per hour

Available to work: Full-time: _______ Part-time: _______

If interested in a part-time position, what days/hours are you available?:

______________________________________________________________________

Were you previously employed by this company? _____ If yes, when?: _____________

List any friends or relatives that are currently employed here: _____________________

______________________________________________________________________

If your application is considered favorably, on what date are you available to begin

work?: ________________________________________________________________

List any previous work experience, skills or qualifications that would make you an

especially good candidate for the position you’re applying for: ____________________

______________________________________________________________________

______________________________________________________________________

List the computer programs you know how to use (Microsoft Word, Excel, Avimark,

Cornerstone, etc.): ______________________________________________________

______________________________________________________________________

List any office machines or veterinary medical equipment you know how to operate:

______________________________________________________________________

______________________________________________________________________

SPECIAL INTERESTS AND HOBBIES

|List any special interests and hobbies you actively participate in outside of work |

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EDUCATIONAL BACKGROUND

| |Name of School |Dates |Did you |Major |

| | |Attended |graduate? | |

| | | |If so, what year? | |

|High School | | | | |

|College/ University | | | | |

|Business/Trade | | | | |

|School | | | | |

|Other | | | | |

|Education | | | | |

WORK HISTORY

Beginning with the most recent, please provide information on all past employers, listing any pertinent experience.

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

|Name of Company |Business Address |Telephone Number |

|Type of Business |Name of Supervisor |Dates Employed |

|Job Title |Starting Wage |Ending Wage |Reason for Leaving |

|Description of Duties/Responsibilities: |

PROFESSIONAL/ACEDEMIC REFERENCES

(Do not list relatives or friends)

|First and Last Name |Telephone Number |How do you know this person? |

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I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.

______________________________________________ __________________

Signature of Applicant Today’s Date

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