Angel Oak Animal Hospital

Position being applied for(Required)

Name(Required)

First Last

Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Do you have the right to work in the U.S.?(Required)

Yes

Position applied for(Required)

When can you start?(Required)

How did you learn of this opening?

How did you learn of this opening? Why are you interested in this position?(Required)

Are there any hours, shifts or days you cannot or will not work?(Required)

Are you interested in a(Required)

Part time position

Full time position

Are you aware that working in a veterinary practice may require you to work extra hours or overtime some days in order to provide emergency care for our patients?(Required)

Yes

Are you willing and able to work these extra hours?

Yes

Do you have an allergy or other medical condition which would limit your capacity or be aggravated by the job for which you have applied?

Yes

If yes, what can be done to accommodate your limitation?

Have you ever been convicted of a felony? (Conviction will not necessarily disqualify an applicant for employment.) *

Yes

If yes, describe conditions

Accident Record and Traffic Convictions for past 3 years, include dates. (Do not include parking violations.)

Education History

High School graduate?

Yes

GED

School Name and Location

Dates Attended

Major

Degree/Diploma

College

Graduate School

Other

Work History

#1

Employer Name

Employer Number

Employer Address

Date Sarted

Starting Salary (per hour)

Starting Position

Date Left

Leaving Salary (per hour)

Leaving Position

Name and Title of Supervisor

Description of Duties

Reason for Leaving

In addition to your work history, what other experiences, skills or qualifications should we know about that would pertain to the position you are applying for?

#2

Employer Name

Employer Number

Employer Address

Date Sarted

Starting Salary (per hour)

Starting Position

Date Left

Leaving Salary (per hour)

Leaving Position

Name and Title of Supervisor

Description of Duties

Reason for Leaving

In addition to your work history, what other experiences, skills or qualifications should we know about that would pertain to the position you are applying for?

#3

Employer Name

Employer Number

Employer Address

Date Sarted

Starting Salary (per hour)

Starting Position

Date Left

Leaving Salary (per hour)

Leaving Position

Name and Title of Supervisor

Description of Duties

Reason for Leaving

In addition to your work history, what other experiences, skills or qualifications should we know about that would pertain to the position you are applying for?

Character References

#1

Name

Phone

Address

#2

Name

Phone

Address

#3

Name

Phone

Address

Declaration

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked unless I have indicated to the contrary. I authorize the references listed above and other individuals who you may contact to provide any and all information concerning my previous employment and any other pertinent information that they may have. Furthermore, I release all parties and persons from any and all liability for damages that may result from furnishing such truthful information as well as from the disclosure of such information by the employer or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of the practice, as amended from time to time in its discretion. I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the employer. I understand that no employee or representative of the practice other than its owner(s) has the authority to enter into agreement for employment for any specified period of time or to make any agreement contrary to that stated in this form. Furthermore, the owner(s) of the practice may not alter the at-will nature of the employment relationship unless he/she/they does(do) so in writing.

I also understand that all offers of employment are conditioned on the provision of satisfactory proof of an applicant’s identity and legal authority to work in the United States.

Signature(Required)

Date(Required)