PERSONAL

First Name

Middle Name

Last Name

Preferred Pronouns

Present Address

City

State

ZIP Code

Permanent Address, If Different From Present

Phone Number:

Mobile Phone

Email:

List All Alias Names, Including Maidan Name

List Any Relatives Or Friends Employed By The Company

Relationship

Are you authorized to work for any employer in the U.S.?

Yes

EMPLOYMENT

Position Desired

Salary Desired:

What Days And Hours Are You Available For Work?

Are You Over 16 Years Of Age?

Yes

If No, Can You Provide A Work Permit?

Yes

Are You Able To Preform The Essential Functions Of The Job For Which You Are Applying?

Yes

When Are You Able To Begin Work?

Do You Have Reliable Transportation

Yes

*We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions

Skills

Do You Speak, Write Or Understand Any Foreign Language?

Yes

Language(S)

Are You Able To Operate A Personal Computer?

Yes

Types Of Software

List Other Office Machines You Can Operate

Specific Skills/Training: What Knowledge, Special Skills And/Or Individual Capabilities Do You Have Which Especially Prepare You For The Position Applied For?

EDUCATION

Type of School

Explain

Name & Location

# Years Completed

Graduated

Degree/Diploma

Area Of Study

Add another school?

Yes

Name & Location

# Years Completed

Graduated

Area Of Study

MILITARY

Military Branch

Reserves

Yes

Service Dates

Rank At Discharge

Discharge Status

REFERENCES

Name

Phone Number or Email

Address

Relationship

Length Of Time Known

Add another reference?

Yes

Name

Phone Number or Email

Address

Relationship

Length Of Time Known

Add another reference?

Yes

Name

Phone Number or Email

Address

Relationship

Length Of Time Known

AUTHORIZATION

I certify that the facts contained in the application are true and complete to the best of my knowledge and that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release Care Animal Hospital from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representation from Care Animal Hospital has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Care Animal Hospital representative.

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Signature

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