Application for Employment Online Form


Fill out the following form and submit it online. Saves you on printing costs, saves your time, and helps you to go green!

Date:
Personal Data
Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Positions Applied For
Receptionist
Veterinary Assistant
Groomer
Certified Veterinary Technician
Kennel Attendant
Housekeeper
Times You're Available
Days
Evenings
Part-Time
Full-Time
Holidays
Weekends
Number of Days Per Week:
Number of Hours Per Week:
Date Available to Start:
Ideal Starting Wage:
Where would you like to be in 1 year?:
Previous Employer #1 (Most Recent)
Employer Name:
From:
To:
Duties of Responsibilities:
Address:
Hourly/Salary:
Start/Final:
Job Title:
Supervisor:
Phone No::
Reason for Leaving:
Previous Employer #2
Employer Name:
From:
To:
Duties of Responsibilities:
Address:
Hourly/Salary:
Start/Final:
Job Title:
Supervisor:
Phone No::
Reason for Leaving:
Previous Employer #3
Employer Name:
From:
To:
Duties of Responsibilities:
Address:
Hourly/Salary:
Start/Final:
Job Title:
Supervisor:
Phone No::
Reason for Leaving:
Previous Employer #4
Employer Name:
From:
To:
Duties of Responsibilities:
Address:
Hourly/Salary:
Start/Final:
Job Title:
Supervisor:
Phone No::
Reason for Leaving:
Education
Years Completed:
School Location Diploma/Degree Studies
High School
Vocational/Trade School
College/University
Specialized Training, Apprenticeship, and/or Extracurricular Activities
Honors, Awards, Copyrights, or Patents
Special Job-Related Skills and Qualifications from Employment or Other Experience
Professional, Trade, Business, or Civic Organizations/Offices
You may exclude organizations that indicate race, color, religion, national origin, disability, or other protected status
Personal
If under 18 years of age, can you provide proof of eligibility to work?
Yes    No
Have you ever applied to us before?
Yes    No
If so, when?
Have you ever been employed with us before?
Yes    No
If so, when?
Are you presently employed?
Yes    No
If so, may we contact your employer? (Yes/No)
Do you have a relative or friend employed with us?
Yes    No
If so, who?
Have you ever been convincted of a crime (other than a traffic violation)?
Conviction will not necessarily disqualify you from employment
Yes    No
If so, please explain:
If applying for a position that requires driving, do you have the required license?
Yes    No
Availability
On what day will you be available to work?:
Full Time
Part Time
Shift Work
Temporary
References Other Than Relatives
Reference #1
Name:
Address:
Phone No.:
Reference #2
Name:
Address:
Phone No.:
Reference #3
Name:
Address:
Phone No.:
Reference #4
Name:
Address:
Phone No.:
Applicant's Acknowledgement

(This application shall be considered active for no more than 45 days. After that time, applicants will be required to submit a completed application. The applicant understands that neither this document nor any offer of employment from this employer constitutes an employment contract unless a specific document is executed in writing by the employer and the employment.)

I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision.

In the event I am employed, I understand that any false or misleading information I knowingly provided in my application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me.

I understand that nothing in this application, or in any prior or subsequent written oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by the Eau Claire Animal Hospital, my employment will be "at-will," for an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of the Eau Claire Animal Hospital or myself.

I understand that I have the right to end my employment at any time and that the Eau Claire Animal Hospital retains the same right. I also understand that no one has the authority to enter into any contract, agreement, or modification of the foregoing unless such contract, agreement, or modification is in writing and signed by Dr. Craig Johnson.
2504 Mall Dr. Eau Claire, WI 54701. 715-835-5011. Fax: 715-835-0993. Site Designed and Hosted by Wireless Wisconsin LLC.