Deason Animal Hospital Employment Form
Deason Animal Hospital Employment Form
Email address
Date:
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Position Applying For:
Your answer
Full-time work?
Part-time work?
Full Name:
Your answer
Address:
Your answer
City:
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State:
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Zip Code:
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Cell Phone Number:
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Home Number:
Your answer
Best time to contact you:
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Social Security Number:
Your answer
Driver’s License Number:
Your answer
Education:
High School
Your answer
College or University
Your answer
Business, Trade, Correspondence or Night School
Your answer
Other
Your answer
List any special honors, recognitions, awards
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Are there any other work experiences, skills or special trainings that you feel wouldqualify you for this position? Please add any additional comments you think areimportant for us to consider.
Your answer
Work History
(Beginning with the most recent, list all past employers, including any pertinent military
experience. If self-employed, provide the business name and business references. A
job offer may be contingent upon acceptable references.)
1.Name of Business
Your answer
Business Address
Your answer
Type of Business
Your answer
Contact Person/Supervisor
Your answer
Phone Number
Your answer
Exact Job Title
Your answer
Description of Duties
Your answer
Start Date
MM
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DD
/
YYYY
Ending Date
MM
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DD
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YYYY
Starting Weekly Pay
Your answer
Ending Pay
Your answer
Reason for Leaving
Your answer
2.Name of Business
Your answer
Business Address
Your answer
Type of Business
Your answer
Contact Person/Supervisor
Your answer
Phone Number
Your answer
Exact Job Title
Your answer
Description of Duties
Your answer
Start Date
MM
/
DD
/
YYYY
Ending Date
MM
/
DD
/
YYYY
Starting Weekly Pay
Your answer
Ending Pay
Your answer
Reason for Leaving
Your answer
3.Name of Business
Your answer
Business Address
Your answer
Type of Business
Your answer
Contact Person/Supervisor
Your answer
Phone Number
Your answer
Exact Job Title
Your answer
Description of Duties
Your answer
Start Date
MM
/
DD
/
YYYY
Ending Date
MM
/
DD
/
YYYY
Starting Weekly Pay
Your answer
Ending Pay
Your answer
Reason for Leaving
Your answer
4.Name of Business
Your answer
Business Address
Your answer
Type of Business
Your answer
Contact Person/Supervisor
Your answer
Phone Number
Your answer
Exact Job Title
Your answer
Description of Duties
Your answer
Start Date
MM
/
DD
/
YYYY
Ending Date
MM
/
DD
/
YYYY
Starting Weekly Pay
Your answer
Ending Pay
Your answer
Reason for Leaving
Your answer
Personal References:
( not former employers or relatives)
1.Name
Your answer
Occupation
Your answer
Years Acquainted
Your answer
Address
Your answer
Phone Number
Your answer
2.Name
Your answer
Occupation
Your answer
Years Acquainted
Your answer
Address
Your answer
Phone Number
Your answer
3.Name
Your answer
Occupation
Your answer
Years Acquainted
Your answer
Address
Your answer
Phone Number
Your answer
Employment Application Questionnaire
(Please place your initials in the ( ) areas)
Position Applying For
What days and hours are you available for work?
Your answer
If hired, on what date will you be available to start working?
MM
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DD
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YYYY
Salary desired
Your answer
List any friends or relatives that work here, other than spouse
Your answer
High School Graduate
College Graduate
If you answer yes to attending/enrolling please list your school hours and days
Your answer
Have you previously applied here?
If yes, when?
Your answer
If hired, can you furnish proof you are eligible to work in the United States?
Have you ever worked for a Veterinarian/Animal Care Facility before?
yes, what were your duties?
Your answer
How long did you work for them?
Your answer
Are you at least 18 years old?
Do you have reliable transportation?
Do you enjoy meeting the public?
Do you currently smoke?
Do you have any responsibilities that might conflict with the job attendance?
Have you ever been convicted of a felony or serious misdemeanor?
If yes, please explain (a conviction will be considered only as relates to fitness to perform the job being sought)
Your answer
Would you have difficulty lifting a 35 lbs. dog into a cage four feet off the floor?
In the last five years have you been discharged by an employer?
f yes, please give Employer
Your answer
Address
Your answer
Reason
Your answer
For driving positions only: Do you have a valid driver’s license?
Driver’s license number
Your answer
Type/Class of license
Your answer
State
Your answer
Has your driver’s license been revoked or suspended in the last 3 years?
Do you expect to be out of town any specific holidays?
If yes, please list
Your answer
Are you available to do work weekends/holidays?
Do we have permission to check and verify previous employment and references?
What would you expect after 1 year employment?
Your answer
Why are you applying for work at Deason Animal Hospital?
Your answer
Do you own any pets?
Please list Names, Ages and Species of your pets
1.
Your answer
2.
Your answer
3.
Your answer
4.
Your answer
5.
Your answer
6.
Your answer
7.
Your answer
8.
Your answer
Note: 1. We comply with the ADA and consider reasonable accommodations measures that may benecessary for eligible applicants to perform essential functions. 2. Hiring may be subject to passing amedical examination, and to skill and /or agility test. 3. At the interview you will be asked to complete askills and personality test.

Please read next page and sign authorization.
Deason Animal Hospital, Inc.1712 D St Floresville, Texas 78114 830-393-4567
Employment Authorization
I
Your answer
(Name) certify that the facts contained in this application and attachedare true and correct and complete statements and I
Your answer
(Name) understand thatand agree to have any of the statements checked by a Deason Animal Hospital, Inc.representative. You are also giving Deason Animal Hospital, Inc. permission to conduct acriminal back ground check on you at any time before employment or after employment if hired.I also understand that Deason Animal Hospital, Inc. may request an investigative consumerreport from a consumer report agency. This report may include information of my character,reputation, personal characteristics, and mode of living. I understand that falsification ofinformation on this application may result in failure to receive an offer or if I am hired, in mydismissal from employment. If you do not understand anything in this application or attachedforms please ask for assistance. I authorize the investigation of any and all statementscontained in this application and also authorize any person, school, current employer, pastemployer, and organization named in this application to provide relevant information andopinions that may be useful in making a hiring decision. I release any persons or organizationsfrom legal liability in making such statements. I understand I may be required to successfullypass an alcohol/drug screening examination: I hereby consent to a pre-and/or post-employmentalcohol/drug screen as a condition of employment. I also consent to the release of any or allmedical information as may deemed necessary to judge my capability to do work for which I amapplying. By signing this form you are giving former employers and references to releaseinformation to Deason Animal Hospital, Inc. If employed, I understand that I have been hired atthe will of the employer and my employment may be terminated at any time, with or withoutreason and with or without notice. I have read and understand, and by my signature consent tothese statements. Date
MM
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Signature
Your answer
This application and forms will be kept for six months and then the information will be destroyedunless you are hired.
A copy of your responses will be emailed to the address you provided.
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