Application For Employment


APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the basis of race, religion, national origin, color, age, veteran status or disability.
We are a non-smoking facility except in designated areas..
It is our intention that all qualified applicants be given equal opportunity and that selection decisions based on job-related factors.

Personal

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Are you applying for Full-Time?Part-Time?
If full-time employment is desired, is there anything that would prevent you from working from Monday through Friday 7:30 a.m.
Saturday from 8:00 a.m. or staying after 6:00 p.m. Monday through Friday or staying after 12:00 (noon) should we have an emergency case that requires last minute medical attention?


If not available full-time specify days and hours you are available and not available for :
Were you previously employed by this organization? YesNo
when?


List any friends or relatives working here, other than spouse

If your application is considered favorably, on what date will you be available for work? 20
For what length of time are you seeking employment?
Are there any other work experiences, skills, or qualifications that you feel would especially fit you for work here? Please add
additional comments you think are important to consider



Employees may be subject to drug testing and background checks

Are you 18 years of age or older? YesNo
Do you have a valid driver’s license? YesNo
Have you had your driver’s license revoked or suspended in the last 3 years? YesNo
If hired, can you furnish proof you are eligible to work in the United States? YesNo
Have you ever been convicted of a felony ? YesNo
If yes, please explain
Have you previously applied here ? YesNo
If yes, when ?


Personal References (not former employers or relatives)

Name & occupation Address Phone number


Membership in Professional or Civic Organization (do not include racial, religious, or nationality groups)

Name or description of organization Active from ---to Offices held


Education Record

# Name of school Degree awarded grade average Honors
High School
College or University
Business, trade, correspondence or night school
Other
Do you type? YesNo WPM


Work History (begin with most recent, list all past employers, including any pertinent military experience)

Name of Company Business address City State Phone
Type of Business Immediate supervisor Date employed From ------ To
Exact job title Earnings at hire At termination Reason for termination




Name of Company Business address City State Phone
Type of Business Immediate supervisor Date employed From ------ To
Exact job title Earnings at hire At termination Reason for termination




Name of Company Business address City State Phone
Type of Business Immediate supervisor Date employed From ------ To
Exact job title Earnings at hire At termination Reason for termination




Name of Company Business address City State Phone
Type of Business Immediate supervisor Date employed From ------ To
Exact job title Earnings at hire At termination Reason for termination




Disclosure of Working Conditions

South County Animal Hospital is a small, large and exotic animal veterinary practice. In the course of your employment you
can expect to encounter events that could be considered psychologically uncomfortable or physically challenging. We feel it is
important to communicate these possibilities of these events before you begin work since this may affect your performance here at
the hospital.

  1. Lifting 40 – 50#.
  2. Restraining unruly dogs or cats of any size.
  3. Working after hours if needed for proper patient care.
  4. Distressed, grieving and/or angry clients.
  5. Unruly and/or aggressive animals.
  6. Severely injured animals.
  7. Dead animals.
  8. Pain and distress of animals.
  9. Feces, urine, blood, pus, other fluids, and detached body parts of animals.
  10. Foul odors.
  11. Drugs, chemicals and x-rays potentially harmful to pregnancy or respiratory conditions (asthma, etc).
  12. Cold / hot temperatures.
  13. Exposure to weather conditions while doing outdoor tasks.
  14. Routine veterinary elective procedures such as tail docks and / or the declawing of animals.

Affidavit
I certify that the above answers given by me to the foregoing questions and statement are true and correct without consequential omissions of any kind whatsoever.
I agree that the company shall be not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in
this questionnaire. I also authorize the companies, schools or persons named above to give information regarding my employment, character or qualifications. I
hereby release said companies from all liability for any damage for issuing this information. I understand drug testing may be a requirement of employment, either
before or during my employment with South County Animal Hospital. I understand that there is no express or implied contract of employment and that if
employed I have been hired at the will of the employer and that my employment may be terminated at will, at any time: and with or without cause the employer’s
only obligation being to pay salary or wages due and owing at the time of termination. I understand that if I become a smoker or carry cigarette odor that is cause
for termination. Finally, I understand that all company property must be returned and my indebtedness to the company must be paid before or at the time of my
termination. I authorize the company to deduct from the final pay check all monies due and owing to the company