Cumberland Valley Animal Hospital, PSC
Application for Employment
(Please PRINT or TYPE and complete ALL information)
CVAH, PSC is an at-will, equal opportunity employer and will not discriminate against any applicant
on the basis of any characteristic that is protected by state or federal law.
Before you apply: Please be aware that working in a veterinary hospital, as with any medical profession, may pose certain health risks. Some employees may choose to be vaccinated against rabies and all should be current on tetanus shots. Persons who are allergic to animals should not apply. Pregnant women need to be especially careful when working with cats and medicines. If you have questions about your health as it pertains to working at CVAH, PSC, please ask your doctor before filling out this application.
Area Applied for: ____________________________ Date of Application: ___________________________
Date You Can Start: ______________________________________ Are you 18 years old or older? Yes / No
Preferred Name: _______________________________ Social Security: _________-______ _____________
Full Legal Name: __________________________________________________________________________
Mailing Address, City, State, Zip: _____________________________________________________________
Street Address, City, State, Zip: _______________________________________________________________
Home Phone Number: ____________________________ Best Time to Call: __________________________
Other Phone Numbers _______________________________________________________________________
Are there any hours or days of the week you cannot work? Yes / No If yes, when? ______________________
Salary Desired: _______________ Type of Employment: Full-Time (30+ hours) / Part-Time
Are you employed now? Yes / No If yes, may we contact your current employer? Yes / No
Have you applied here before? Yes / No When? ____________ Under what name? ____________________
Are you lawfully entitled to be employed in the United States? Yes / No
Have you been convicted of a crime within the last 7 years? (Conviction will not necessarily disqualify you from employment.) Yes / No If yes, please explain: ____________________________________________________
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Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel will be helpful to us in considering your application.
_________________________________________________________________________________________
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EDUCATION:
Elementary School & Address: ________________________________________________________________
High School & Address: _____________________________________________________________________
Did you graduate? Yes / No If no, did you get your General Education Degree (GED)?
College & Address: _________________________________________________________________________
Did you graduate? Yes / No What did you study? __________________________________________
Specialty School & Address: _________________________________________________________________
Did you graduate? Yes / No What did you study? __________________________________________
REFERENCES: (3 individuals not related to you that have known you for at least one year
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
EMERGENCY CONTACT:
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
CURRENT AND FORMER EMPLOYERS: (Most Recent First)
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
Employment Dates: ____________________________ Start & End Salaries: ____________________
Job Title: _______________________ Responsibilities: _____________________________________
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
Employment Dates: ____________________________ Start & End Salaries: ____________________
Job Title: _______________________ Responsibilities: _____________________________________
Name: ____________________________________ Relation to you: ________________________________
Address: ___________________________________________ Phone: _________________________
Employment Dates: ____________________________ Start & End Salaries: ____________________
Job Title: _______________________ Responsibilities: _____________________________________
Please read the following statement carefully before signing to indicate your understanding:
I understand that if I receive a conditional job offer, prior to beginning employment I may be requested to undergo a pre-employment medical examination. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application may result in termination. I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS AT-WILL. THIS MEANS THAT, IF I AM HIRED, EITHER CUMBERLAND VALLEY ANIMAL HOSPITAL, PSC OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON. I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers to provide you with all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to CVAH, including but not limited to any defamation claims I may now have or will have against them.
Signature: ___________________________________________ Date: _______________________________
CUMBERLAND VALLEY ANIMAL HOSPITAL, PSC IS AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER
Applications are always accepted and are kept on file for one year. Due to our low employee turnover and employees who return to work during college breaks, we will probably not be hiring when you turn in your application. We do not call applicants until we have an opening and are setting up interviews, which may not be for several months.
To return by FAX: 606-864-9153 |