Job Application

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603

(907)235-8960

www.homervet.com

Job Application Form

Job Position Sought:

Full Name:

Previous/maiden name:

Address
Street Address
City
,
State / Province
Zip / Postal Code
How long have you been at this address:

Phone
Phone TypePhone Number
E-Mail Address :
Age

Student
Y
N
Do you have transportation?
Yes
No
Position applied for:
Animal Care Attendant
Veterinary Assistant
Veterinary Technician
Receptionist
Availability: Year round, permanent or Seasonal or temporary ( please describe limitations)

Are you seeking part-time or full-time employment?

If part-time only, how many hours do you want to work?

Hours you are routinely available to work:

What rate of pay do you expect?

Why do you want to work at Homer Veterinary Clinic?

What are your educational goals for the next 5 years?

What are your career goals for the next 5 years?

Are you eligible for employment in the United States?
Yes
No

Have you ever been convicted of a felony or misdemeanor or are you presently/formally charged with committing any criminal offense? (Do not include traffic violations, juvenile offenses, military convictions except by general court martial). It the answer is yes, furnish details of conviction, offense, location, date and sentence? (a conviction will not necessarily disqualify an applicant from employment)

Yes
No
If Yes:

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.
Yes
No
Do you agree to pre-employment drug testing?
Yes
No
Have you ever been terminated from a job because of stealing or other criminal conduct?
Yes
No
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 Homer Veterinary Clinic with a copy of your pet’s veterinary records for review?
Yes
No
Animal Handling experience?
Yes
No
Any allergies to animals? Please list.

Education:
High School:

Graduated?
Yes
No
College

Graduated?
Yes
No
Degree (or major if currently a student)

Are you planning to enroll in college?
Yes
No
Do you have any certifications, degrees, awards or special skills that we should know about?

Employment:
Current or most recent employer:

Employed from: :
To: :
Address and phone:

Position title:

Duties:

Reason you left the position:

Hourly rate of pay: (list starting and 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 have worked with:
Name/ Phone/ Occupation/ Company

Name/ Phone/ Occupation/ Company

Name/ Phone/ Occupation/ 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/ Company

Name/ Phone/ Occupation/ Company

Name/ Phone/ Occupation/ Company

Agreement
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. • I authorize the Homer Veterinary Clinic to check employment references and verify education information provided or this employment application and as disclosed at the interview process. • I authorize the Homer Veterinary Clinic to run a criminal history background check as a condition of employment. • I release the Homer Veterinary Clinic 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 40lbs alone or over 40 lbs with assistance. I will be constantly standing, stooping, walking and lifting the majority of every working day.
Agreement
Yes
No

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