Kleinbrook Animal Hospital
(281) 444-8387
APPLICATION FOR EMPLOYMENT
The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion or national origin. Public Law 90-202 prohibits discrimination because of age. The laws of some states prohibit some or all of the above mentioned types of discrimination.
PLEASE PRINT NEATLY
Texas drivers license # ______Date ______
Name: ______
LastFirst Middle
Date of Birth ______/______/______email: ______
Month Day Year
PRESENT ADDRESS ______
Street City State Zip
How many years have you lived at this address? ______
HOME/CELL TELEPHONE (_____) ______-______WORK TELEPHONE (_____) ______-
PREVIOUS ADDRESS: ______How long? ______
POSITION APPLIED FOR:
1)______RATE OF PAY EXPECTED ______
2)______RATE OF PAY EXPECTED ______
Do you want to work ( ) Full-time or ( ) Part-time
If Part-time, specify days and hours available ______
If hired, on what date would you be available to start? ______
What skills and special talents do you have which would qualify you to work with us? ______
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Are you employed now? ______Yes ______No May we contact your present employer? ______(y or n)
Are you prevented from lawfully becoming employed in this country because of VISA or Immigration status ______Yes ______No. (Proof of citizenship or immigration status will be required upon employment.)
Have you been convicted of a felony within the last 7 years? ______Yes ______No
If yes, please explain ______
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Are you a veteran of the U.S. Military Service? ______Yes ______No Which branch? ______
Indicate the languages you speak, read and/or write ______
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Give Name, Address and Telephone # of three references who are not related to you and are not previous employers:
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EMPLOYMENT EXPERIENCE
Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.
1. Employer ______Dates Employed ______
Address ______Telephone # ______
Job Title ______Supervisor ______
Reason for leaving ______
Starting Salary ______Final Salary ______
Work performed ______
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2. Employer ______Dates Employed ______
Address ______Telephone # ______
Job Title ______Supervisor ______
Reason for leaving ______
Starting Salary ______Final Salary ______
Work performed ______
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3. Employer ______Dates Employed ______
Address ______Telephone # ______
Job Title ______Supervisor ______
Reason for leaving ______
Starting Salary ______Final Salary ______
Work performed ______
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Please check the following applicable skills and experiences.
Surgery ( )Anesthesiology ( )EKG ( ) X-Ray ( ) Venipuncture ( ) Animal Restraint ( )
QBC-V ( )Blood chemistry machine ( ) Heartworm exam ( ) Fecal exam ( ) Physical Exam ( )
Animal grooming/bathing/dipping ( ) Nail trim ( ) Dental prophylaxis ( ) CPR ( )
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Typing ( )Computer operation ( ) Filing ( ) Answering telephones ( ) Word processing ( )
Accounting/Bookkeeping ( ) Collections ( ) Credit Card processing ( ) Inventory ordering ( )
Inventory control ( ) Fax machine ( ) Copier ( )
EDUCATION
High SchoolCollege/UniversityGraduate/Prof.
School Name
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Years completed
______
Diploma/Degree
______
Honors Received
______
Other
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Do you have reliable transportation? ______
Do you have any physical limits which might prevent you from performing specific kinds of work? ______
If yes, please describe and explain limitations: ______
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Have you had a serious illness in the past five years? Please explain. ______
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Will the hours of this job impose a hardship? ______
Are you able to work overtime, or on an on-call basis? ______
Do you have commitments at home or elsewhere that may take you away from work? ______(y or n) Please explain ______
What would you say is your best quality? ______
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What is your worst quality? ______
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Who should be contacted in case of emergency?
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NamePhone Number
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AddressRelationship
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time.
SIGNATURE OF APPLICANT______DATE ______
WITNESSED ______DATE ______
APPLICANT GOALS
Please complete each question to the best of your ability
Name ______
Date ______
POSITION APPLYING FOR: ______
1)Please write out your goals for the position for which you are applying.
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2)Please write out your understanding of the purpose of a veterinary practice.
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3)Please write a brief letter to a client who has an overdue account. You may use the other side of the page if you wish. Please do this even though you may not be handling financial matters in the performance of your job.
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