HAC Employment Application

Personal Information
SocialS E-Mail:
First Name: Middle Initial Last Name:
Address Line 1: Address Line 2:
City: State: Zip Code:
Home Phone: Business Phone: Cell Phone:
Work Preference
Date Available Position Applying For:
Expected Wage: Employment Requested: Full Time Part Time Temporary
Education
High School Name/Location: Diploma Received: Diploma Equivalency None
College Name/Location: Degree Earned Yes or No
Attended from: Attended To: Major/Minor:
College Name/Location: Degree Earned Yes or No
Attended from: Attended To: Major/Minor:
Employment History (Begin with most recent)
Name Of Employer: Address Line 1:
City: State: Zip Code:
Employed From: Employed To: Employer Phone:
Job Title: Supervisor Name: Reason For Leaving:
Previous Hourly Wage
Name Of Employer: Address Line 1:
City: State: Zip Code:
Employed From: Employed To: Employer Phone:
Job Title: Supervisor Name: Reason For Leaving:
Previous Hourly Wage
Name Of Employer: Address Line 1:
City State: Zip Code:
Employed From: Employed To: Employer Phone:
Job Title: Supervisor Name: Reason for Leaving:
Previous Hourly Wage
Professional References
Please list three references that have knowledge of your professional experience.
Reference Name: Address:
Occupation: Phone:
Reference Name: Address:
Occupation: Phone:
Reference Name: Address:
Occupation: Phone:
Background
Do you have pets?
Why would you like to work with a veterinarian?
Do you have any allergies to animal hair/dander, chemicals, etc.?
Do you smoke?
Have you ever been discharged by an employer? If so, what were the circumstances?
Why did you leave your previous job or why are you considering leaving your current position?
Do you possess any relevant special skills, abilities, animal history, or personal qualities?
Why should you be selected for this job?
What salary do you expect?
What salary and benefits do you expect after one year of employment?
What days and times are available to work?
Are you available to work weekends?
Are you available to work holidays?
Is it okay to check references and/or prior work history?
Have you ever pled no contest, guilty, or been convicted of a felony or a first degree misdemeanor? If yes, Explain:
Are you a U.S. Citizen or are you legally authorized to work in the U.S.?
If a position is currently unavailable, would you like us to consider you when a position becomes available? Yes No Only for the next 60 days.
I understand that if I am hired, the employment shall be at the will of either party and may be terminated by either party at any time. I grant permission to check my past employment references as well as my personal references as part of the application process. I certify that if employed, falsified statements on the application shall be sufficient cause for dismissal.
Electronic Signature of Applicant* Date*
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