Employment Opportunities

Date: *

Full Name: *

Present Address: *

Apartment, suite, etc:

City: *

State/Province: *

ZIP / Postal Code: *

How long:

Phone: *

Email Address *

If under 18, please list age:

Position applied for: *

Salary desired (Be specific): *

How many hours can you work weekly? *

Can you work nights? *

Employment desired: *FULL-TIME ONLYPART-TIME ONLYFULL- OR PART-TIME

When are you available for work? *

Education

Highschool

Name of School:

Location (Complete mailing address):

Number of Years Completed:

Major & Degree:

College

Name of School:

Location (Complete mailing address):

Number of Years Completed:

Major & Degree:

Bus. or Trade School

Name of School:

Location (Complete mailing address):

Number of Years Completed:

Major & Degree:

Professional School

Name of School:

Location (Complete mailing address):

Number of Years Completed:

Major & Degree:

Have you ever been convicted of a crime? *YesNo

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Do you have a driver's license? *YesNo

What is your means of transportation to work? *

Have you had any accidents during the past three years? *

How many? *

Have you had any moving violations during the past three years? *

How many? *

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Work Experience #1

Name of employer: *

Name of last supervisor: *

Street Address: *

City: *

State/Province: *

ZIP / Postal Code: *

Phone number: *

Employment From: *

Employment To: *

Start Pay or salary: *

Final Pay or salary: *

Your last job title: *

Reason for leaving (be specific): *

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. *

Work Experience #2

Name of employer:

Name of last supervisor:

Street Address:

City:

State/Province:

ZIP / Postal Code:

Phone number:

Employment From:

Employment To:

Start Pay or salary:

Final Pay or salary:

Your last job title:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Work Experience #3

Name of employer:

Name of last supervisor:

Street Address:

Apartment, suite, etc:

City:

State/Province:

ZIP / Postal Code:

Phone number:

Employment From:

Employment To:

Start Pay or salary:

Final Pay or salary:

Your last job title:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer? *YesNo

Did you complete this application yourself: *YesNo

If not, who did?

References

Please list two references other than relatives or previous employers.

Reference #1

Name: *

Position: *

Company: *

Street Address: *

City: *

State/Province: *

ZIP / Postal Code: *

Phone number: *

Reference #2

Name: *

Position: *

Company: *

Street Address: *

City: *

State/Province: *

ZIP / Postal Code: *

Phone number: *

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. *

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Hassayampa Veterinary Services (hereinafter called “HVS”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, or policy statements, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of HVS. It does not change in any respect the employment-at-will relationship between it and the undersigned, and only a written instrument signed by the owner of the practice can alter that relationship. Both the undersigned and HVS may end the employment relationship at any time, without specified notice or reason. If employed, I understand that HVS may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give HVS permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release HVS from any liability as a result of such contract. I authorize HVS to perform a background check.

I further understand that my employment with HVS shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with HVS is terminable at will for any reason by either party.

Signature of applicant: *

Date: *

HVS is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with HVS depends solely on your qualifications.

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Education

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

References

Please list two references other than relatives or previous employers.

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER