Employment Application


It is the policy of Carlsbad Animal Hospital to provide equal employment opportunities to all employees and applicants for employment. All employment practices such as recruitment, selection, promotions, and other terms and conditions of employment are administered in a manner designed to ensure that employees and applicants for employment or services are not subjected to discrimination on the basis of age, race, color, sex, sexual orientation, national origin, citizenship status, uniform service member status, ancestry, protected medical condition, genetic information, disability, marital status, religious or political preferences or union affiliation or any other protected status in accordance with all applicable federal, state and local laws.



Date

Your Name (Last First Middle ) *required

Present Address (Street City State Zipcode)

Cell #
Home #:

Permanent address if different from present address (Street City State Zipcode)

Position applying for

Are you applying for  Regular full-time work Regular part-time work

What days and hours are you available for work?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you available to work overtime, if necessary?  Yes  No

If hired, on what date can you start date?

Salary Desired

Have you ever applied to or worked for Carlsbad Animal Hosptial before?  Yes  No

If yes, when?

Do you have any friends or relatives working for Carlsbad Animal Hospital?  Yes  No

If yes, state name(s) and relationship

Why are you applying for work at Carlsbad Animal Hospital?

If hired, do you have a reliable means for transportation to and from work?  Yes  No

If hired, can you furnish proof that you are over 18 years of age?(If under 18, hire is subject to verification that you are of minimum legal age)  Yes No

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in the United States  Yes No

Are you able to perform the essential functions of the job for which you are applying?
 Yes No

If no, describe the functions that cannot be performed

Have you ever pled guilty or “no contest” to, or been convicted of, a misdemeanor or felony?  Yes  No

Have you been arrested for any matters for which you are currently out on bail or on your own recognizance pending trial?  Yes  No

If yes, please give the date(s) and details

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for many, however, be considered).

Are you currently employed?  Yes No

If so, may we contact your current employer?  Yes No

EMPLOYMENT HISTORY 1

Present or Last Employer:

Phone Number:

Address                                                     City            State           Zipcode

Start Date (Month & Year):

End Date (Month & Year):

Job Title:

Summary of Duties

Reason for Leaving:

Supervisor Name:

Supervisor Phone Number:



EMPLOYMENT HISTORY 2

Present or Last Employer:

Phone Number:

Address                                                     City            State           Zipcode

Start Date (Month & Year):

End Date (Month & Year):

Job Title:

Summary of Duties

Reason for Leaving:

Supervisor Name:

Supervisor Phone Number:



EMPLOYMENT HISTORY 3

Present or Last Employer:

Phone Number:

Address                                                     City            State           Zipcode

Start Date (Month & Year):

End Date (Month & Year):

Job Title:

Summary of Duties

Reason for Leaving:

Supervisor Name:

Supervisor Phone Number:



EDUCATION, TRAINING & EXPERIENCE

School Name

Address

Years Completed

Did you Graduate?

Degree/Diploma Received

High School




 Yes  No


College/University




 Yes No


Vocational/Business




 Yes No


Health Carel




 Yes No



Do you have any other experience, training, qualification or skills which you feel make you especially suited for work at Carlsbad Animal Hospital. If so, please explain:

Are you licensed/certified for the job applied for? Yes No

Name of license/certification

Issuing state License/certification number

Has your/certification ever been revoked or suspended?  Yes No

If yes, state reason(s), date of revocation or suspension and date of reinstatement

MILITARY SERVICE

Have you obtained any special skills or abilities as the result of services in the military.
If so, describe:

REFERENCES
List below three persons not related to you who have knowledge of your work performance within the last three years.

Name:

Job Title:

Years Acquainted:

Address:

Phone Number:

Cell:
Work:


Name:

Job Title:

Years Acquainted:

Address:

Phone Number:

Cell:
Work:


Name:

Job Title:

Years Acquainted:

Address:

Phone Number:

Cell:
Work:

This application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.

I certify that all of the information that I have provided on this application is true and accurate.

Your Email (required)

Subject

Your Message