APPLICATION FOR EMPLOYMENT

Transcription

1 APPLICATION FOR EMPLOYMENT DATE: NAME: LAST FIRST MIDDLE ADDRESS: STREET CITY STATE ZIP PHONE # HOME: CELL# DATE OF BIRTH: SEX: SOCIAL SECURITY #: POSITION APPLIED FOR: RATE OF PAY: FULL TIME PART TIME IF PART TIME, WHAT HOURS HAVE YOU EVER APPLIED FOR A POSITION HERE? DO YOU HAVE ANY ILLNESS OF PHYSICAL CONDITION THAT MAY LIMIT YOUR ABILITY TO DO THE JOB YOUR ARE APPLYING FOR? IF YES, PLEASE EXPLAIN: WHAT METHOD OF TRANSPOTATION WILL YOU USE TO GET TO WORK? ARE THERE ANY OTHER EXPERIENCES, SKILLS, OR QUALIFICATIONS WHICH YOU FEEL WOULD EXPECIALLY FIT YOU FOR WORK WITH US? WITHIN THE PAST 5 YEARS, HAVE YOU BEEN CONVICTED OF A FELONY, OR WITHIN THE PAST 2 YEARS, OF ANY MISDEMEANOR OR ARE YOU PRESENTLY FORMALLY CHARGED WITH COMMIITING ANY CRIMINAL OFFENSE? (DO NOT INCLUDE ANY TRAFFIC VIOLATIONS, JUVENILE OFFENSES OR MILITARY CONVICTIONS, EXCEPT BY GENERAL COURT MARTIAL.) IF THE ANSWER IS YES, FURNISH DETAILS OF CONVICTION, OFFENSE, LOCATION, DATE AND SENTENCE. NO YES (EXPLAIN) IN THE PAST 3 YEARS HAVE YOU KNOWINGLY USED ANY NARCOTICS, AMPHETAMINES OR BARBITURATES, OTHER THAN THOSE PRESCRIPED TO YOU BY A PHYSICIAN? NO YES (EXPLAIN) DO YOU USE ILLEGAL DRUGS? YES NO WOULD YOU AGREE TO AND PASS PERIODIC ROUTINE DRUG TESTS? DO YOU SMOKE? YES NO HAVE YOU EVER BEEN TERMINATED FROM A JOB BECAUSE OF STEALING OR OTHER CRIMINAL CONDUCT? NO YES (EXPLAIN)

2 EDUCATION NAME & LOCATION YEARS DATE SUBJECTS ATTENDED GRADUATED STUDIED HIGH SCHOOL COLLEGE/ VO-TECH EMPLOYMENT RECORD (most current job first) DATE REASON FOR MONTH & YEAR EMPLOYED BY PHONE NUMBER POSITION SALARY LEAVING HOBBIE/ACTIVITES: REASON FOR APPLYING FOR THIS JOB:

3 REFERENCES (Not related to you that you have known for more than 1 year.) NAME PHONE NUMBER OCCUPATION YEARS KNOWN I understand that any verbal or written statement 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 by 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. I authorize Haas Animal Clinic to check employment references and verify education information provided on this employment application and as disclosed in the interview process. I authorize Haas Animal Hospital to run a criminal history background check as a condition of employment. I release Haas Animal Hospital and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process. Applicant Signature

4 1. Who is the only President of the United States to resign his office? 2. Who is the current Governor of Louisiana? 3. What is significant about the date July 4, 1776? 4. What is the decimal equivalent of ¼ ; ¾ ; 1/3 5. What is the decimal equivalent of the following weights from ounces to pounds? 4oz. = #; 7oz. = #; 16oz. = # 6. If you purchased an item for $9.47 and you gave the cashier $20.02, how much Change, would you receive? 7. Ten percent of $32.59 is 8. If you purchased an item for $11.67 and the sales tax on that item is 9%, how Much, sales tax do you owe? SPELLING Please circle correct spelling. A. Patent B. Pashient C. patient D. Pateint A. Diarrhea B. Diahrreah C. Diareah D. Diarreaha A. Cliente B. Cliant C. Client D. Cleint A. Priscription B. Prescription C. Perscriptian D. Prescreptien A. Vetrinerrian B. Vetinarian C. Veterinarian D.Vatrinarian 1. Tell us about yourself. a. Do you plan on going to school or college? Y N, If so When? Area of study

5 b. Do you have any pets? Y N What kind? c. Please circle one: Do you consider pets --- as a part of the family OR property? d. Why do you want to work in a veterinary clinic? e. Have you ever worked in an animal related field? Describe 2. Tell us what you think the job entails that you are applying for. 3. How do you think you would do around blood, vomit, diarrhea, and pus? 4. The clinic hours are: 7:30am-6pm or later Monday-Friday, and 7:30am-12noon or later on Saturday, with one day off during the week. Will you have any conflict with the schedule? 5. Weekend work will be required, Saturday evening, Sunday morning and evening. The weekend work is rotated between workers. Would you have any problems with this? _ 6. Pay starts at minimum wage ($8.00/hr) with a 90 day probation period. Will there be any problems working for this amount? 7. Tell us anything else that you feel we should know about you. 8. How well do you think you work with others? 9. Do have problems taking instructions/orders from other people?. PLEASE SUBMIT YOUR RESUME (IF AVAILABLE) AND PLEASE COMPLETE OUR APPLICATION. Incomplete applications are voided. THANK YOU FOR YOUR INTEREST IN HAAS ANIMAL HOSPITAL!