Please Note: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please write N/A. PERSONAL INFORMATIONName First Last Address Street Address City State / Province / Region ZIP / Postal Code Alternate Address Street Address City State / Province / Region ZIP / Postal Code Home PhoneMobile PhoneEmail Job TypePOSITION SOUGHT AFTER: Available State Date MM slash DD slash YYYY Seeking (check one) Full-Time Part-Time Available for (check applicable shift(s)): First Shift Second Shift Third Shift Days & Hours available to work:Start Time:Mon.Tue.Wed.Thu.Fri.Sat.Sun.End Time:Mon.Tue.Wed.Thu.Fri.Sat.Sun.Desired Pay Range: How did you learn about our company? ADDITIONAL INFORMATION Have you ever been employed by this organization in the past? Yes No If yes, when was the start and end dates of employment, as well as position?Started date:Ended date:Position:Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment(s) to a felony? Yes No If Yes, please explain:Do you have a driver’s license? Yes No If Yes, Driver’s license Number: Issued in what State? EDUCATIONHigh School:Location (mailing address):Years completed:Major:Degree/Diploma: Add RemoveCollege or Business/Trade School:Location (mailing address):Years completed:Major:Degree/Diploma: Add Remove MILITARYHave you ever been in the Armed Forces? Yes No Date entered: MM slash DD slash YYYY Are you now a member of the National Guard? Yes No Date discharged: MM slash DD slash YYYY WORK EXPERIENCE Note: Please list ALL work experience beginning with your most recent job held. Attach additional sheets if necessary. Company: Address Street Address City State / Province / Region ZIP / Postal Code PhoneStarting Position & Date: Ending Position & Date Last Supervisor's Name: May we contact the Employer? Yes No Job Description:Reason for leaving (be specific):WORK EXPERIENCE CONTINUES Note: Please list ALL work experience beginning with your most recent job held. If you are attaching a resume you may skip this section. Company: Address Street Address City State / Province / Region ZIP / Postal Code PhoneStarting Position & Date: Ending Position & Date Last Supervisor's Name: May we contact the Employer? Yes No Job Description:Reason for leaving (be specific):Company: Address Street Address City State / Province / Region ZIP / Postal Code PhoneStarting Position & Date: Ending Position & Date Last Supervisor's Name: May we contact the Employer? Yes No Job Description:Reason for leaving (be specific):Company: Address Street Address City State / Province / Region ZIP / Postal Code PhoneStarting Position & Date: Ending Position & Date Last Supervisor's Name: May we contact the Employer? Yes No Job Description:Reason for leaving (be specific):SKILLS, TRAINING & CERTIFICATION(S)REFERENCES Note: List below three persons not related to you, whom you have known for at least one year. Name:Address:How does this person know you?Phone: Add RemoveIf you were to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements. AUTHORIZATION I certify that the facts contained in this application (and accompanying cover letter and resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by Catapuss Veterinary Services, LLC dba Adamson Veterinary Services. I understand that any employment is conditioned on a background check. I authorize the Catapuss Veterinary Services, LLC dba Adamson Veterinary Services to thoroughly investigate all statements contained in my application or accompanying correspondence(s), and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to Catapuss Veterinary Services, LLC dba Adamson Veterinary Services, without giving me prior notice of such disclosure. In addition, I release Catapuss Veterinary Services, LLC dba Adamson Veterinary Services, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained in this application, accompanying correspondence(s) or conveyed during any interview, is intended to create an employment contract. I further more understand and agree that if I were to be hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or Catapuss Veterinary Services, LLC dba Adamson Veterinary Services. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Catapuss Veterinary Services, LLC dba Adamson Veterinary Services unless made in writing by an authorized Catapuss Veterinary Services, LLC dba Adamson Veterinary Services representative. If I am offered employment, I agree to submit to a medical examination and drug test, if required before starting employment at Catapuss Veterinary Services, LLC dba Adamson Veterinary Services. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Catapuss Veterinary Services, LLC dba Adamson Veterinary Services and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to Catapuss Veterinary Services, LLC dba Adamson Veterinary Services the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test(s), if required, and if I am hired a condition of my employment will be that I abide by Catapuss Veterinary Services, LLC dba Adamson Veterinary Services’ Drug and Alcohol Policy. I understand that acceptance of this form does not indicate there is a position open and does not obligate Catapuss Veterinary Services, LLC dba Adamson Veterinary Services to hire. If hired, I agree to abide by all Catapuss Veterinary Services, LLC dba Adamson Veterinary Services’ work rules, policies and procedures. Catapuss Veterinary Services, LLC, dba Adamson Veterinary Services retains the right to revise its policies or procedures, in whole or in part, at any time.Applicant’s Signature:Date MM slash DD slash YYYY Upload Resume Drop files here or Select files Max. file size: 128 MB, Max. files: 4.
