Talega Animal Hospital - Employment Application

1
Name
Date
Position Desired
Minimum Salary
How did you learn about us?
Ever applied here before?
Telephone Number
Alternate number
2
Employment Eligibility
Please Select
Please Select
Yes
No
Are you a citizen of the U.S.?
Please Select
Please Select
Yes
No
If not, do you have legal right to work in the U.S.?
Please Select
Please Select
Yes
No
Are you 16 years of age or older?
If not, please specify age
Please Select
Please Select
Yes
No
Do you speak or read any languages fluently besides English?
If yes, which one(s)
Please Select
Please Select
Yes
No
Have you ever been convicted of a felony crime?
Please Select
Please Select
Yes
No
Are there any criminal charges pending against you?
3
Signature* This field is required. Background testing is an employment requirement. I understand that if I am offered a position, a background test will be required.
Clear
4
Signature* This field is required.Drug-Free Screening is an employment requirement. I understand that if I am offered a position, drug screening will be required prior to my employment.
Clear
5
Education
Name of School
City / State
Degree / Major
High School
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College / University
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Graduate School
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Row 2, Column 2
Trade School
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Row 3, Column 1
Row 3, Column 2
High School
College / University
Graduate School
Trade School
Name of School
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City / State
Row 0, Column 1
Degree / Major
Row 0, Column 2
Name of School
Row 1, Column 0
City / State
Row 1, Column 1
Degree / Major
Row 1, Column 2
Name of School
Row 2, Column 0
City / State
Row 2, Column 1
Degree / Major
Row 2, Column 2
Name of School
Row 3, Column 0
City / State
Row 3, Column 1
Degree / Major
Row 3, Column 2
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Employment History #1
Employment Dates
Employers Name & Address
Position / Job Duties
Reason for leaving
Wage/salary
7
Employment History #2
Employment Dates
Employers Name & Address
Position / Job Duties
Reason for leaving
Wage/salary
8
Employment History #3
Employment Dates
Employers Name & Address
Position / Job Duties
Reason for leaving
Wage/salary
9
Is any information relative to change in name, use of an assumed name, maiden name, or nickname necessary to check your work record or background information?
Yes
No
10
If yes, please provide other names
11
Do you authorize us to contact your previous and present employer for reference prior to employment with this business?
Yes
No
12
Authorized Signature* This field is required.
Clear
13
Is there anything else you would like us to know about you?
14
Please upload a copy of your resume
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Max. file size: 10.6MB
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15
Applicant’s Affidavit:
I certify that the information contained in this application is correct to the best of my knowledge. I authorize investigation of all matters contained in this application and agree that any misleading or false statements would be cause for rejection of this application or would be sufficient cause for dismissal after employment begins. I understand that employment is contingent upon the receipt of negative drug screening results, background check, and satisfactory work references by Talega Animal Hospital. I further understand that my continued employment will be based on my satisfactory job performance and the satisfactory completion of the Benefits Waiting period of employment.
16
Signature* This field is required.
Clear
17
Date* This field is required.
Date
Year
Month
Day
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