Position of interest

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email address

Phone

(###)

###

####

EMPLOYMENT HISTORY

Do you have work experience?

Current / previous employment (no less than three)

Employer name 1

Supervisor name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Start date

YYYY

End date

YYYY

Position title

Hourly wage

Primary duties / responsibilities

Permission to contact

Do we have permission to contact this employer as a reference?

Yes

Employer name 2

Supervisor name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Start date

YYYY

End date

YYYY

Position title

Hourly wage

Primary duties / responsibilities

Permission to contact

Do we have permission to contact this employer as a reference?

Yes

Employer name 3

Supervisor name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Start date

YYYY

End date

YYYY

Position title

Hourly wage

Primary duties / responsibilities

Permission to contact

Do we have permission to contact this employer as a reference?

Yes

EDUCATION

School

Enrollment start date

YYYY

Enrollment end date

YYYY

Type of degree

CERTIFICATIONS / LICENSURE

Certification type

Issue date

YYYY

Expiration

YYYY

Certification license number

Certification type

Issue date

YYYY

Expiration

YYYY

Certification license number

References

PLEASE LIST THREE INDIVIDUALS WHO ARE IN A POSITION TO EVALUATE YOUR PERFORMANCE, EXPERIENCE, AND ACCOMPLISHMENTS.

Reference name 1

First Name

Last Name

Relationship to Reference

Company

Phone

(###)

###

####

Reference name 2

First Name

Last Name

Relationship to Reference

Company

Phone

(###)

###

####

Reference name 3

First Name

Last Name

Relationship to Reference

Company

Phone

(###)

###

####

Why are you interested in this position?

Signature

I understand that if hired, I will serve a voluntary period of introductory employment, generally up to 90 days, during which I may separate myself or be separated involuntarily without notice. I understand that any offer of employment is contingent upon passing a criminal background check and authorize Stayton Veterinary Hospital to run one. I release Stayton Veterinary Hospital and all providers of information from any liability as a result of furnishing and receiving any information related to the hiring process. I am affirming that I am physically capable of carrying out my job which includes lifting up to 50 pounds and being on my feet for the majority of the work day. I am affirming the statements I have made on this application and that any additional written or oral information is true. I understand that any false statements, misrepresentation or material omission is sufficient ground for the hospital to reject this application and employment. Typing your name in the field below represents a digital signature.

THANK YOU FOR COMPLETING THIS ONLINE APPLICATION. WE WILL BE IN CONTACT REGARDING OUR NEXT STEP IN THE HIRING PROCESS IF YOU ARE SELECTED FOR AN INTERVIEW. WE LOOK FORWARD TO MEETING YOU.

Employment Application

Thank you for your interest in becoming a member of our care team. Complete the form and we will contact you after further review. If you prefer to complete this application on paper, use our printable PDF version and mail or deliver to our clinic with a copy of your resume.