Employment Application
   
Today's Date:__________________
 
Full Name:____________________ Social Security Number: ___________________
United State Citizen: Yes  No Are you authorized to work in the US on an unrestricted basis? Yes  No
When would you be available to start?_____________

Address: __________________________________

_________________________________________

____________________________________

 Phone: (_____)_______________

email address: _______________________________________
Our Company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability which is not job- related.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

Questions

Are there any restrictions on your schedule that might limit your ability to work the hours that we are open? Yes No If yes, please explain:

_________________________________________________________________________________________________
_________________________________________________________________________________________________

Have you ever been convicted of or pled guilty to a crime, either a misdemeanor or a felony (including but not limited to
drug-related charges, child abuse, other crimes of violence, theft, or motor vehicle violations)? Yes No If yes, please explain:

__________________________________________________________________________________________________
__________________________________________________________________________________________________

Education:
High School______________________ Dates attended:__________ Graduated Yes  No
College_________________________ Dates attended:__________ Graduated Yes: Degree_____  No
College_________________________ Dates attended:__________ Graduated Yes: Degree_____  No

Work History: (please explain any gaps during which you were neither employed nor in school.
EMPLOYER SUPERVISOR JOB TITLE & DUTIES EMPLOYMENT DATES PAY RATES REASON FOR LEAVING
PRESENT OR LAST Co. Name:
 
Address:
 
City/State/Zip:		 Name:
 
Phone:
 
May we contact?		   From:
 
To:		 First:
 
Last:		  
PREVIOUS Co. Name:
 
Address:
 
City/State/Zip:		 Name:
 
Phone:
 
May we contact?		   From:
 
To:		 First:
 
Last:		  
PREVIOUS Co. Name:
 
Address:
 
City/State/Zip:		 Name:
 
Phone:
 
May we contact?		   From:
 
To:		 First:
 
Last:		  
PREVIOUS Co. Name:
 
Address:
 
City/State/Zip:		 Name:
 
Phone:
 
May we contact?		   From:
 
To:		 First:
 
Last:		  

References:
Name: __________________________________
Address:_________________________________		 Occupation: _____________
Years acquainted: _________		 Phone: (____)___________
 
Name: __________________________________
Address:_________________________________		 Occupation: _____________
Years acquainted: _________		 Phone: (____)___________
Are there any restrictions on your schedule? If so, what:
 
 
Rate yourself in the following areas (1=Low; 5 = High) Please add comments
 
Prompt, gets to work on time
 
Flexible, does not view job area rigidly
 
Cheerful, helpful to clients/coworkers
 
Responsible
 
Compassionate, particularly with animals
 
Efficient, uses time effectively
 
Thorough, completes tasks
 
Able to take initiative and see what needs to be done
 
Organized
 
Telephone skills
 
Computer skills, Typing skills
 
AGREEMENT
I certify that the answers given herein are true and complete, without misrepresentation, to the best of my knowledge. I understand that misrepresentation of any facts will be cause for dismissal. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I further agree to a physical examination if such is required as a condition of employment. I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of the job.

I understand that this application does not constitute a written contract of employment. I further understand that, if offered, employment is for no definite period or time and may be terminated at any time at the will of employer or employee, without any previous notice.


______________________________________________ ____________________________________________________
Signature Date

 
To apply for a position with Veterinary Vision,
print this form, then mail or the completed application to:
Veterinary Vision, Inc.
210 Industrial Rd. Ste#100.
San Carlos, CA 94070
650•551•1115 FAX 650•5510-0100
 
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