Job Application Form - Countryside Vet

Countryside Job Application

Date:
Full Name:
Your Email Address:
Previous/Maiden Name:
Current Address:
How long at this address:

Telephone Number(s): Working Voicemail Box Required to apply!
Age: Are you 18 years of age or older?YesNo
Student: YesNo
Are you seeking part-time or full-time employment? If part-time, how many hours do you want to work?Full-timePart-time
Hours you are routinely available to work: Any hours I am needed. Limited hours (describe limitations).
What rate of pay do you expect?
Why do you want to work at Countryside Veterinary Service?
What are your career goals in the next 2 years?
What are your career goals in the next 5 years?

Are you eligible for employment in the United States?YesNo
Have you ever been convicted of a felony or misdemeanor or are you presently/formally charged with committing any criminal offense? IF YEŞ furnish details of conviction, offense, location, date, and sentence? (A conviction will not necessarily disqualify an applicant from employment).
In the past 3 years, have you ever knowingly used any narcotics, amphetamines or barbiturates, other than those prescribed to you by a physician? If the answer is yes, furnish details.
Do you agree to pre-employment drug testing?YesNo
Have you ever been terminated from a job because of stealing or other criminal conduct?YesNo

Animal Related History: List all the pets you own; (include names, species and age)
Who is your current veterinarian?
Would you be willing to provide Countryside Veterinary Service with a copy of your pet's veterinary records for review?[checkbox checkbox-copypetrecords? "Yes" "No"]
Animal Handling experience? If yes, share details:[text text-exp?]
Any allergies to animals? Please list:[text text-allergy?]

Education:
High School: Graduated?YesNo
College: Graduated?[checkbox checkbox-grad? "Yes" "No"]
Degree (or major if currently a student).[text text-student?]
Are you planning to enroll in college?[text text-plancollege?]
Do you have any certifications, degrees, awards or special skills that we should know about?

Employment:
Current or most recent employer:
From: To:
Address and phone:
Position title Duties:
Reason you left the position:
Hourly rate of pay: Start Ending

Previous Employer #1:
From: To:
Address and phone:
Position title Duties:
Reason you left the position:
Hourly rate of pay: Start Ending

Previous Employer #2:
From: To:
Address and phone:
Position title Duties:
Reason you left the position:
Hourly rate of pay: Start Ending

List any other prior employers if applicable including name/telephone number and dates employed:
Work related references: List contact information for 3 people you worked with
Name
Phone #
Occupation/Position
Company
Please describe any other relevant experience (volunteer, animal related activities, etc):
Is there anything else you would like us to know when considering your application:
Personal References: List contact information for 3 people who now you well and that we can contact for a personal reference:
Name
Phone #
Occupation/Position
Company
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 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 circumstances, 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. l authorize the Countryside Veterinary Service to check employment references and verify education information provided or this employment application and as disclosed at the interview process. I authorize the countryside Veterinary Service to run a criminal history background check as a condition of employment. I release the countryside Veterinary Service 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 I am physically capable of carrying out my job which will include lifting patients and other items such as dog food, crates, etc. up to 40 lbs. alone or over 40 lbs. with assistance. I will be constantly standing, stooping, walking and lifting the majority of every working day.
By checking this box, I represent that I am electronically signing these documents which will have the same effect as the execution of these documents by a written signature.
I Accept

Thank you for completing this application in detail and we will be in contact regarding the next step in the hiring process if you are selected for an interview.

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