Ark Animal Hospital - Employment Application

Date(Required)

MM slash DD slash YYYY

Your Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Secondary Phone

Position(s) applied for(Required)

Kennel Technician

Veterinary Technician

Receptionist

Would You Work(Required)

Full Time

Part Time

Please Specify Days and Hours if part time:(Required)

Rate of pay expected(Required)

If your application is considered favorable when can you start?(Required)

MM slash DD slash YYYY

Are You 18 years or older?(Required)

Yes

No

If hired, can you furnish proof you are eligible to work in the U.S.?(Required)

Yes

No

Do you smoke?(Required)

Yes

No

Have you ever been convicted of a felony?(Required)

Yes

No

Have you ever been terminated from a job because of stealing or other criminal conduct?(Required)

Yes

No

Can you perform the duties of the job you are applying for?(Required)

Yes

No

Are you able to routinely lift a minimum of 40 pounds?(Required)

Yes

No

Education

Name of most recent school attended?(Required)

Degree or grade level attained(Required)

Do you have any certifications, degrees, awards or special skills we should know about?(Required)

Current or Most Recent Employer(Required)

From(Required)

MM slash DD slash YYYY

To(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Position Title(Required)

Duties(Required)

Reason you left the position(Required)

Hourly rate of pay(Required)

Previous Employer #1

Name

From

MM slash DD slash YYYY

To

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Phone

Position Title

Duties

Reason you left the position

Earnings at hire

Earnings At Termination

Please describe any other relevant experience (volunteer, animal related ,etc..)(Required)

Please List Hobbies(Required)

Is there anything else you would like us to know when considering your application?(Required)

References

Name(Required)

First Last

Relationship(Required)

Phone(Required)

How long have they known you?

Name(Required)

First Last

Relationship(Required)

Phone(Required)

How long have they known you?

Signature