Form - Online Employment Application

NAME (required)
First Name (required)
Last Name (required)
PRESENT ADDRESS (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
PERMANTENT ADDRESS (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
PHONE (required)
Phone TypePhone Number (required)
E-MAIL ADDRESS
E-Mail Address (required) :
REFERRAL
Referred By

EMPLOYMENT DESIRED
Position (required)

Salary Requested (required)

Hours Requested (required)
Full-time
Part-time

Date you can start (required)

Are you currently employed? (required)
(Please select one)
yes
no

If so may we inquire of your current Employer?
(Please select one if applicable)
yes
no

Have you ever applied to Telford Veterinary Hospital before? (required)
(Please select one)
yes
no

If so, When? and Where?

EDUCATION HISTORY
Please list the Name, Location, Years Attended and Subjects Studied in the fields below
GRAMMAR SCHOOL

Did you graduate?
yes
no

HIGH SCHOOL

Did you graduate?
yes
no

COLLEGE

Did you graduate?
yes
no

GRADUATE SCHOOL

Did you graduate?
yes
no

TRADE/TECHNICAL SCHOOL

Did you graduate?
yes
no

GENERAL INFORMATION
Subjects of special study/research work or special skills/training

FORMER EMPLOYERS
List below the last four employers, starting with the most recent first.
PLEASE NOTE: Each Employer section must include: Name and address of Employer, Dates with Employer, Salary, Position and Reason for leaving.
Current or Most Recent Employer (required)

Employer 2

Employer 3

Employer 4

REFERENCES
Give below the names of (3) persons who could serve as professional or personal references.
PLEASE NOTE: The references must be people not related to you, who have known you for at least 1 year with a solid understanding of you as a person. Please include: Name, Address, Business and Years Known.
Reference 1 (required)

Reference 2 (required)

Reference 3 (required)

RESUME (optional)
Please cut and paste a copy of you most recent resume below, please limit to 500 words.

AUTHORIZATION
"I certify that the facts contained in this application are true
and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above may give you any and all information concerning my previous employment and release the company from all liability for any damage that may result from such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by the Practice Owner, Hospital Administrator or authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant state and federal laws. I understand and acknowledge that Telford Veterinary Hospital is an Equal Opportunity Employer (EOE)."
Please select one (required)
I understand and agree with the terms listed above and request that my application is considered for employment
I do not agree with the terms and understand that this selection may remove my application from consideration.


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