Employment Application Personal InformationJob Applied For:Date MM slash DD slash YYYY Driver’s License #:State of issue:Name First Last Home Phone (include area code) Work Phone (include area code) Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Check Only One Full-time Part-time Either Days & Hours you are availableDate You Can Start MM slash DD slash YYYY Work HistoryAre you 18 years of age or older? Yes No If hired, can you furnish proof you are eligible to work in the United States? Yes No Are you capable of performing tasks that include lifting 40 lbs, animal restraint, bending/twisting, being on your feet for an entire shift/? Yes No Do you have any limitations that would prevent your from working in close contact with the handling of animals that may shed hair, have skin problems, or be on topical medications? Yes No Are you available to work on Saturdays, if needed? Yes No What is your hourly rate expectation?Are you currently employed? Yes No If yes, may we inquire of your present employer? Yes No Personal References (not former employers or relatives) NameWhat is the relationship and how long have you known this person? Phone number Add RemoveEducation/Training HistoryList colleges, military, trade, business or other schools attended beginning with most recent. Do you have a high school diploma or a GED certificate? Yes No Personal References (not former employers or relatives) Name and Location of School, College,or University Course of Study (List Major)Did You Graduate? (Yes / No)GPADegree or Certificate Add RemoveAre you licensed? Yes No N/A License eligible? Yes No N/A If so, which board?Last date of continuing education courses attended:Specialized Skills or Knowledge List skills or knowledge that show your ability to perform the job for which you are applying. (Example: a background in using a cash register, copier, computer, computer languages or software programs, typing speed, foreign languages, etc.). Attach additional pages as needed.Work HistoryJob Number 1NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER SUPERVISOR’S NAME and PHONE NUMBER KIND OF BUSINESS YOUR JOB TITLE FROM (MONTH / YEAR)TO (MONTH / YEAR) TOTAL TIME IN POSITION: HOURS WORKED PER WEEK (Average): SALARY PAID: SUPERVISION / LEADWORK - CHECK AREAS YOU WERE RESPONSIBLE FOR: Assigning and Reviewing work Handling Disciplinary problems Rating Work Performance Responding to Grievances Hiring or Recommending Hiring Not Responsible for Any of the Above DUTIES: List all duties you performedReason for leaving this position: May we contact this employer for a reference? Yes No Job Number 2NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER SUPERVISOR’S NAME and PHONE NUMBER KIND OF BUSINESS YOUR JOB TITLE FROM (MONTH / YEAR)TO (MONTH / YEAR) TOTAL TIME IN POSITION: HOURS WORKED PER WEEK (Average): SALARY PAID: SUPERVISION / LEADWORK - CHECK AREAS YOU WERE RESPONSIBLE FOR: Assigning and Reviewing work Handling Disciplinary problems Rating Work Performance Responding to Grievances Hiring or Recommending Hiring Not Responsible for Any of the Above DUTIES: List all duties you performedReason for leaving this position: May we contact this employer for a reference? Yes No Job Number 3NAME OF EMPLOYER EMPLOYER’S ADDRESS and PHONE NUMBER SUPERVISOR’S NAME and PHONE NUMBER KIND OF BUSINESS YOUR JOB TITLE FROM (MONTH / YEAR)TO (MONTH / YEAR) TOTAL TIME IN POSITION: HOURS WORKED PER WEEK (Average): SALARY PAID: SUPERVISION / LEADWORK - CHECK AREAS YOU WERE RESPONSIBLE FOR: Assigning and Reviewing work Handling Disciplinary problems Rating Work Performance Responding to Grievances Hiring or Recommending Hiring Not Responsible for Any of the Above DUTIES: List all duties you performedReason for leaving this position: May we contact this employer for a reference? Yes No Certification and Signature I understand that any verbal or written statement that is false, fraudulent or misleading that is contained in this application or attached materials, or made in the course of any related employment process, whether made by me or by others at my request, will result in rejection of my application, denial of employment, or dismissal from service if discovered after employment, and under some circum-stances, may result in prosecution for a crime. I certify that all statements contained herein are true and complete. I understand that if hired, I must prove that I am legally authorized to work in the United States. I authorize Better Health Animal Hospital to check employment references and verify education information provided on this employment application and as disclosed in the interview process. I authorize Better Health Animal Hospital to check my driving record if the position for which I am applying requires driving. I authorize Better Health Animal Hospital to run a criminal history background check as a condition of employment. I release Better Health Animal Hospital and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.SignatureDate MM slash DD slash YYYY CAPTCHA Δ
