TAC Employment Application

If you are driven to succeed in a position that rewards through customer connections, you thrive in a busy environment and seek a career where your contributions help strengthen the human-animal bond, you may be the team member we are seeking!

Fill the form below accurately indicating your potentials and suitability to job applying for.

Position Applying for *

Salary Desired *

Date Available

Date

Employment Desired *

Part Time Full Time

Name: *

First Name Last Name

Phone Number: *

Area Code Phone Number

E-mail Address: *

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Birth Date

Month Day Year

Drivers License Number/State *

Do You Have A Reliable Source Of Transportation To And From Work? *

Yes No

Are You At Least 18 Years Of Age? *

Yes No

Are You Legally Eligible To Work in the United States? *

Yes No

Do you have any pending criminal charges against you? *

Yes No

Have you ever been convicted of a crime, regardless of whether it was a felony or misdemeanor? *

Yes No

(if yes give dates and details below)

If you answered yes to either criminal background inquiries above, provide the date and county of the pending charge or conviction, the type of charge or conviction, and an explanation. (A pending charge or prior conviction will not automatically bar you from employment.)

The essential functions of most jobs at The Animal Clinic will require that employees lift up to 50 lbs. frequently, bend and stoopfrequently, stand and/or walk long periods of time, some climbing, and work in extreme temperatures.

To the extent these functions may be applicable to the position for which you are applying, can you perform all of the above functions or perform all of the above functions with reasonable accommodation? *

Yes No

Answering “NO” to this inquiry is not an automatic bar to employment. The Animal Clinic is an equal opportunity employer and complies with all facets of the American with Disabilities Act (and any applicable state laws).

Education and Training

What is the highest grade completed in school? *

Do you have a High School Diploma or a GED Equivalency? *

Yes No

Name and Location of High School

Training beyond High School: School name & location

Number of years attended?

Did you Graduate?

Yes No

Describe any other Education or Training which you feel is relevant to the job for which you are applying. (Also include relevant licenses and certifications.

References

Please list two (3) references that are familiar with your work life.

Reference 1

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Years Known: *

What is your relationship? *

Reference 2

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Years Known: *

What is your relationship? *

Reference 3

Name: *

First Name Last Name

Phone Number *

Area Code Phone Number

Years Known: *

What is your relationship? *

Work Experience

Provide a complete description of all jobs. Be specific. Start with your most recent job. For part-time work, show the average number of hours per week. Indicate any changes in job title with the same employer as a separate job.

Most Current Job (1)

Employer: *

Location: *

Dates of Employment: *

Full Time Part Time

Job Title: *

Job Duties *

Wages:

Reason for Leaving: *

Job (2)

Employer: *

Location: *

Dates of Employment: *

Full Time Part Time

Job Title: *

Job Duties *

Wages:

Reason for Leaving: *

Job (3)

Employer: *

Location: *

Dates of Employment: *

Full Time Part Time

Job Title: *

Job Duties *

Wages:

Reason for Leaving: *

May we communicate with your present employer? *

Yes No

May we communicate with your former employer(s) *

Yes No

Have you ever done any volunteer work?

Yes No

If yes, please describe:

Upload Resume:

How were you referred to us? *

Walk-In Employee Indeed Ad Other (please specify)

Others:

BY MY SIGNATURE BELOW, I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE. I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACTS ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of The Animal Clinic to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, sexual orientation, or pregnancy, and to afford equal opportunities to disabled veterans, individuals with a disability, and any and other characteristic protected by federal, state or local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release The Animal Clinic from all liability that might result from making an investigation.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Applicant Signature

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Date