Application For Employment in Las Vegas, NV

AN EQUAL OPPORTUNITY EMPLOYER

We do not discriminate on the basis of any federal or state identified protected status, such as race, religion, national origin, color, sex, age, veteran status, disability or sexual preference. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

PERSONAL

Social Security No

Date

Name*

First Middle Last

Present Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Email*

Position Applied For

Desired Rate

Available to Work

Full Time
Part Time

Specify Days & Hours, If Part Time

Were you previously employed by this organization?

If Yes, When

Who referred you to us?

If your application is considered, on what date will you be available for work?

Are there any other work experiences, skills, or qualifications that you feel would especially fit you for work here?

If you are applying for a job with minimum age requirements, you may be required to submit proof of age. If hired, can you furnish proof you are eligible to work in the United States?

YES
NO

Have you ever been convicted of a felony?

Yes
No

If Yes, Explain

Have you previously applied here?

YES
NO

If Yes, When?

Have you worked for any employer under a different name?

YES
NO

If Yes, Give Name

Each of the following sections needs to be completed. A resume does not substitute for completing these sections.

PERSONAL REFERENCES (Not Former Employers or Relatives)

Name

Address

Years Known

Phone Number

Name and Occupation

Address

Years Known

Phone Number

Name and Occupation

Address

Years Known

Phone Number

Name and Occupation

Address

Years Known

Phone Number

MEMBERSHIP IN PROFESSIONAL OR CIVIC ORGANIZATIONS

(Do not include, racial, religious, or nationality groups)

Name or description of organization

Active Participation (From/To)

Offices Held

Name or description of organization

Active Participation (From/To)

Offices Held

Name or description of organization

Active Participation (From/To)

Offices Held

EDUCATIONAL RECORD

Non Veterinarians Only

High school

Degree/Graduated Y or N

Grade Ave

College or University

Degree/Graduated Y or N

Grade Ave

Other Business Trade, Correspondence or Night School

Degree/Graduated Y or N

Grade Ave

Veterinary Technician Licensing Program

Degree/Graduated Y or N

Grade Ave

Can you use a computer keyboard to enter and retrieve data?

YES
NO

Other office machines you know how to operate

If experienced with veterinary software programs, please list those with which you have worked

EDUCATIONAL RECORD

Veterinarians Only

High School

Degree/Graduated Y or N

Grade Ave

Honors

College or University (Preveterinary)

Degree/Graduated Y or N

Grade Ave

Honors

College (Veterinary Curriculum)

Degree/Graduated Y or N

Grade Ave

Honors

Post training, including internships (include dates and degrees awarded, if any)

Are You

Board Certified?
Board Eligible?

Which Specialty Board?

List continuing education courses attended in the past 18 months

List the states in which you are licensed to practice along with license numbers

WORK HISTORY

Begin with the most recent. List all past employers including any pertinent military experiences. Explain any time gaps, a resume does not substitute for completing this section.

Name of Company

Business Address

Phone

Type of Business

Immediate Supervisor

Dates Employed

Exact Job Title

Earning at Hire

At Termination

Reason for Termination

Description of duties

Name of Company

Business Address

Phone

Type of Business

Immediate Supervisor

Dates Employed

Exact Job Title

Earning at Hire

At Termination

Reason for Termination

Description of duties

Name of Company

Business Address

Phone

Type of Business

Immediate Supervisor

Dates Employed

Exact Job Title

Earning at Hire

At Termination

Reason for Termination

Description of duties

RESUME

Please attach your resume below

Accepted file types: doc, docx, pdf, odt, rtf, Max. file size: 356 MB.

AFFIDAVIT

I CERTIFY that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me form further consideration and may result in my dismissal if discovered at a later date. I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from neighbors, friends and former employers, schools and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements, contained in this application and also authorize any person, school, current employer (except as previously note), 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 any statement. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEES EMPLOYMET FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I MAY HAVE BEEN HIRED AT TEH WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I have read, understand, and by my signature consent to these statements.

Affidavit:*

I agree/consent

Signature*

Date*