Name:

First

Middle

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number:

Email:

If hired, can you provide evidence of legal eligibility to work in the U.S.?

Yes
No

Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorization.

Yes
No

Position Desired:

Wage/Salary Desired:

Work Type

Full Time?
Part Time?

Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?

Yes
No

If yes, when and where?

Date you can begin work?

Are you 18 years of age or older?

Yes
No

If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by California or federal law.

Yes
No

Name of high school attended:

City & State

Graduate?

GED?

Name of college or technical school:

City & State

Graduate?

GED?

Major:

Are you presently enrolled in school?

Yes
No

If yes, give name & address of school and expected degree date:

List any job-related skills or accomplishments, including military service:

Your Availability For Work

Monday

From:

To:

Tuesday

From:

To:

Wednesday

From:

To:

Thursday

From:

To:

Friday

From:

To:

Saturday

From:

To:

Sunday

From:

To:

Total hours per week you are available to work:

Do you have any special requests or needs for a work schedule?

Give Three References That Are Not Former Employers Who We May Contact

Name and Occupation

How do you know them, and for how long?

Phone Number

Your Employment History

List names of employers with present or last employer listed first.

Please note if we may not contact your present employer until after you are offered a position.

Employer 1:

Name of Employer:

Job Title:

Address:

Duties:

City, State, Zip Code

Dates of Employment:

From: and To:

Supervisor:

Hourly pay or salary:

Starting pay: and Ending pay:

Telephone:

Reason for Leaving:

Employer 2:

Name of Employer:

Job Title:

Address:

Duties:

City, State, Zip Code

Dates of Employment:

From: and To:

Supervisor:

Hourly pay or salary:

Starting pay: and Ending pay:

Telephone:

Reason for Leaving:

Employer 3:

Name of Employer:

Job Title:

Address:

Duties:

City, State, Zip Code

Dates of Employment:

From: and To:

Supervisor:

Hourly pay or salary:

Starting pay: and Ending pay:

Telephone:

Reason for Leaving:

CAREFULLY READ EACH STATEMENT BEFORE SIGNING AT THE BOTTOM

I certify that all of the information provided in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date.

I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Fort Hunt Animal Hospital, any employment relationship with the Fort Hunt Animal Hospital is considered “employment at will.” This means the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause, and with or without advance notice.

I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I have read, understand, and agree to the above statements.

Signature

Clear Signature

Date

Veterinary Jobs in Alexandria, VA