NAME*

First Last

POSITION DESIRED

Address

Street Address City State ZIP Code

HOME PHONE #

ALTERNATE PHONE #

DATE AVAILABLE TO START

MINIMUM WAGE DESIRED

ARE YOU UNDER THE AGE OF 18?

Yes
No

EDUCATION

School Name	Years Completed	GPA	Area of Study

ADDITIONAL QUALIFICATIONS

(List any knowledge, skills, activities, hobbies or awards that are relevant to this position)

Please indicate the hours you would be available to work each day (i.e. 8 am-7 pm)

REFERENCES (List 3 individuals not related to you whom you have known for at least 1 year.)

NAME	PHONE NUMBERS	HOW AQUAINTED

REASONS FOR WANTING THIS POSITION

DO YOU SMOKE?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OR EMPLOYEE OF A RADICAL ANIMAL RIGHTS GROUP SUCH AS PETA, ALF, etc.?

WORK EXPERIENCE

EMPLOYER	ADDRESS	PHONE #	POSITION	SUPERVISOR’S NAME	REASON FOR LEAVING

(List all previous employers in the past 5 years, starting with the most recent.)

APPLICANT STATEMENT*

I agree to the statement below:

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge.

I agree to have any of the statements I have made checked unless I have indicated to the contrary. I authorize the references listed and other individuals who you may contact to provide any and all information concerning my previous employment or any other pertinent information they may have. Furthermore, I release all parties and persons from any and all liability for damages that may result from furnishing such truthful information as well as from the disclosure of such information by the employer or any of its employees or representatives. I understand that Cascade Heights Veterinary Center reserves the right to require drug testing of all applicants and employees at any time, and that drug testing, a police background check, and/or a credit check may be required prior to hiring. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer, or if I am hired, my dismissal from employment.

I understand that all offers of employment are conditioned on the provision of satisfactory proof of an applicant’s identity and legal authority to work in the United States.

Employment Application

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