Employment Application Broadview Veterinary Group, PLLC

Thank you for your interest in seeking employment with our hospital. We look forward to discussing with you further any potential employment opportunites.

Location Applying For: (OK to select multiple) *

Dover, NH Rochester, NH Milton, NH

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

How were you referred to us? *

Walk-In Employee Online Ad Facebook Client Other

Position applying for: *

Type of employment desired: (Select all that apply) *

Full - Time (Avg. 32 hours up to 40 hours) Part - Time (Avg. less than 32 hours) Seasonal / Temporary

If hired, can you furnish proof you are eligible to work in the U.S.? *

Yes No

Select applicable age: *

Employment History

Are you currently employed? *

Yes No Yes, but notice has been given / position is ending.

May we contact your present or past employer(s)? *

Yes No Not at this time (Request Confidentiality)

Resume

Upload Resume (Optional)

Most Recent Employer (Disregard if on resume)

Please provide business: Name, address, phone number, supervisor name, your title, employment dates and reason for leaving if applicable.

Prior Employer (Disregard if on resume)

Please provide business: Name, address, phone number, supervisor name, your title, employment dates and reason for leaving if applicable.

Job Skills & Training

Describe your skills:

Training or Certifications:

Any additional information that you feel would be important for us to know about:

References

Please list two (2) references that are familiar with your work life.

Reference 1

Name:

First Name Last Name

Phone Number

Area Code Phone Number

Years Known:

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Reference 2

Name:

First Name Last Name

Phone Number

Area Code Phone Number

Years Known:

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Application Statement

We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic infromation or any other legally protected status.

By Submitting this application:

I certify that answers given herein are true and complete.

I autorize investigation of all statements contained in this application.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and ackowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

By signing below this serves as my digital signature of authorization and agreement with the above terms effective the current date listed below. *

Clear

Current Date *

Date

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