Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you 18 years or older? (You may be asked to show proof that you are an adult.) *

Yes
No

Have you ever been convicted of a crime other than a minor traffic offense? *

Yes
No

Please explain by listing any convictions, dates, nature of the offense and where it occurred. *

Do you have the legal right to work in the United States? You will be asked to verify this upon employment.) *

Yes
No

What position are you applying for? *

Indicate hours that you are available to work: *

Please list the hours you are available for each day of the week.

High School Attended, City, and State *

Please List Any College Attended, City, State, Date of Attendance, Degree Received

Job Related Training or Course Work Completed

Licensure, Registration, Certification

Present or Last Employer *

Kind of Business *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor's Name *

Date of Employment *

Starting Position

Final Position

Starting Pay

Final Pay

Reason for Leaving

List any other experience, skills or qualifications which you believe should be considered in evaluation your qualifications for employment.

I acknowledge that in connection with my application for employment with Village Gate Animal Hospital & Pet Resort (VGAHPR), that management of VGAHPR may make inquiries as to my character, general reputation, and any characteristics that may affect my job performance. I hereby authorize all personnel, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any and all information concerning my background, and release the same from any liability resulting from providing such information. I also acknowledge that from time to time, VGAHPR may be required to submit certain information with regard to my employment or application therefore to various local, state and federal government agencies. I hereby authorized VGAHPR to provide such information and release VGAHPR, its agents, assigns and subsidiaries from any liability resulting from submitting such information. *

I have read and understand.

I understand that the employment relationship is at at-will employment relationship. Either party may terminate the employment relationship at any time with or without cause in the sole discretion of either party. I further understand that no verbal agreement, prior to or after this agreement, may alter this relationship. Furthermore, no person acting on behalf of VGAHPR is authorized to expressly or implicitly alter this policy, except in an express, written contract signed by the Owner and Business Manager of VGAHPR. Longevity of employment, commendations, and promotions, while desired objectives, do not alter the rights of the employee or VGAHPR to terminate employment in their sole discretion. *

I have read and understand.

I also acknowledge that I have been informed that veterinary hospitals use X-ray equipment and chemical substances that may cause injury to a fetus. I agree to notify my supervisor immediately if I become pregnant and that the policy of VGAHPR requires a doctor’s letter for continued employment. *

I have read and understand.

I hereby certify that all statement and answers set form on this application form are complete and true, and I understand that if subsequent to employment and such statements and/or answers are found false or that information has been omitted, such false statements or omissions will be just cause for termination of my employment. *

I have read and understand.

Signature *

Please type your name.

Date *