Employment Application Personal InformationName* First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home PhoneCell PhoneEmployment AvailabilityPosition Applied For* Can you furnish eligibility to work in the U.S.?*Select belowYesNoAre you currently employed?*Select belowYesNoMay we contact your current employer?*Select belowYesNoHave you ever been employed by Anchor Animal Hospital in the past? If so, when? Salary DesiredPer Hour Available Start Date MM slash DD slash YYYY Availability Mon Tue Wed Thu Fri Sat Sun Part Time (< 30 hours) Full Time (>30 hours) Education RecordPlease list all schools / educationPlease list High School, College/University and Other / Trade / Training / Certifications / Qualifications School TypeName & LocationYear of GraduationSubjectsGPA Other Relevant InformationTechnical TrainingSpecial Skills / Qualifications / ActivitiesPrevious EmploymentPrevious EmployersPlease list your last four employers, starting with with present or most recentDates EmployedEmployer’s Name/Tel. #PositionReason for leaving Professional ReferencesMy ReferencesDo NOT list friends or relativesNameTelephone NumberProfessionYears Acquainted CertificationBy completing this employment application form I certify that all information I have provided in this application is true and completely accurate. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application and authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application, to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I will be required, as a condition of employment, to pass a CORI check, drug screening, and physical examination. I hereby consent to a pre- and/or post-employment screening, which is permitted by law and required as a condition of employment based upon successfully passing. I consent to any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that this application, verbal statements by management, or subsequent employment does not create an expressed or implied contract or guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason, and with or without notice. I have read and understood these statements to be true and consent by completing this form.PhoneThis field is for validation purposes and should be left unchanged.
