Employment Application

Position Desired?*

Minimum Salary*

Who referred you to this hospital?

Have you ever applied to this hospital before?*

Yes

No

Who should we notify in case of an emergency?*

Emergency Phone Number*

Are you a citizen of the U.S.?*

Yes

No

Are you 16 year's of age or older?*

Yes

No

Have you ever been convicted of a felony crime?*

Yes

No

Are there any criminal charges pending against you?*

Yes

No

We are a Drug-Free workplace. I understand that if I am considered for employment I would be required to submit samples for drug and alcohol testing prior to my employment. By typing my name below I am stating that I understand this policy.*

I have read and agree

I understand that if I am considered for employment, hospital policy requires that I submit a background check as part of the pre-employment screening process. By typing my name below I am stating that I understand this policy.*

I have read and agree

What High School Did you attend?*

High School Address*

How many years did you complete?

Did you attend College?*

Yes

No

Did you attend Graduate School?*

Yes

No

Name of previous employer*

Start Date*

End Date*

Position or Job Title

Reason for leaving?*

Salary or Hourly Wage*

Would you like to add a second previous job?

Yes

No

Would you like to add a third previous job?

Yes

No

Is any information relative to change in name, use of an assumed name, maiden name, or nicknames necessary to check your work record?*

Yes

No

Do you authorize us to contact your previous and present employers for reference prior to employment with this business?*

Yes

No

Employment Application

Join the team at ABC Animal & Bird Clinic.

Position Desired?*

Minimum Salary*

Who referred you to this hospital?

Have you ever applied to this hospital before?*

Who should we notify in case of an emergency?*

Emergency Phone Number*

Are you a citizen of the U.S.?*

Are you 16 year's of age or older?*

Have you ever been convicted of a felony crime?*

Are there any criminal charges pending against you?*

We are a Drug-Free workplace. I understand that if I am considered for employment I would be required to submit samples for drug and alcohol testing prior to my employment. By typing my name below I am stating that I understand this policy.*

I understand that if I am considered for employment, hospital policy requires that I submit a background check as part of the pre-employment screening process. By typing my name below I am stating that I understand this policy.*

What High School Did you attend?*

High School Address*

How many years did you complete?

Did you attend College?*

Did you attend Graduate School?*

Name of previous employer*

Start Date*

End Date*

Position or Job Title

Reason for leaving?*

Salary or Hourly Wage*

Would you like to add a second previous job?

Would you like to add a third previous job?

Is any information relative to change in name, use of an assumed name, maiden name, or nicknames necessary to check your work record?*

Do you authorize us to contact your previous and present employers for reference prior to employment with this business?*

Please list any special qualities you possess that would make you an asset to our hospital.