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INDIAN VALLEY ANIMAL HOSPITAL
EMPLOYMENT APPLICATION DATE_____________
NAME:____________________________________ SOCIAL SECURITY NUMBER:__________________________
ADDRESS:_________________________________________________________________________________________
HOME PHONE:___________________________ WORK PHONE:___________________________________
APPLYING FOR:
_____ Full time ______Part time _____Weekends
POSITION WANTED:
____ Reception ______ Technician _____Assistant _____ Kennel Attendant ______ Groomer
EDUCATIONAL BACKGROUND:
High School_____________________________________ Graduated: ( ) Yes ( ) No ( ) GED Date ___________
College_________________________________________ Graduated: ( ) Yes ( ) No Date ___________
QUALIFICATIONS/SKILLS:
WHAT RELATED EXPERIENCES COULD YOU CONTRIBUTE TO OUR PRACTICE?
WORK HISTORY: (Begin with most recent)
Employer:___________________________ Name of Supervisor ____________________ From_____/___ To_____/___
Address:____________________________________________________________________________________________
Duties:________________________________________________________________________Salary________________
Reason For Leaving:________________________________________________________Hrs/Wk___________________
Employer:___________________________ Name of Supervisor ____________________ From_____/___ To_____/___ Address:____________________________________________________________________________________________
Duties:________________________________________________________________________Salary________________
Reason For Leaving:________________________________________________________Hrs/Wk___________________
Employer:___________________________ Name of Supervisor ____________________ From_____/___ To_____/___
Address:____________________________________________________________________________________________
Duties:________________________________________________________________________Salary________________
Reason For Leaving:________________________________________________________Hrs/Wk______
REFERENCES: Full Name Home or Business Address Phone Number Occupation
1._________________________________________________________________________________________________
2._________________________________________________________________________________________________
3._________________________________________________________________________________________________
Please give us 5 attributes that you can consistently bring to our hospital that will make you indispensable.
(each should be only 1 word) 1.___________________________ 2._____________________________ 3. _______________________ 4.___________________________ 5._____________________________
This application does not constitute a written employment agreement.
In the event that the applicant agrees to accept a position with the company, the applicant agrees that the employment relationship between the Indian Valley Hospital is an at-will relationship and that the employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or the employee.
I certify that the information contained in this application is correct. If the company determines that any of the information submitted in this application is false, I shall be immediately disqualified from consideration for employment and/or discharged from employment in accordance with company policy.
I hereby grant permission to the company to investigate the information contained in this application and release the company and any agents or other persons acting on behalf of the company from any and all liability relating to any investigation of the information contained in this application. I also grant you permission to obtain a credit report on myself.
_____________________________
Signature of Applicant
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