Employment Application - Vet Tech Last Name * First Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Email * Have you ever been convicted of a crime? (Exclude minor traffic infractions. DUI’s must be noted.) * Yes No If yes, please explain and list the date of the conviction: Are you prevented from lawfully being employed in the country because of Visa or Immigration status? (Proof of citizenship will be required upon employment.) * Yes No Position Desired: * Date available to begin work: * How did you hear about this job? * Please list friends and relatives in our employment: * Were you previously employed with Heart of the Valley? * Yes No If yes, when? Employment History: (Please include any relevant volunteer experience.) Employer * Address * Phone * Job Title * Pay Rate * Dates of your employment: * Describe your job: * Reason for leaving: * Employment History: Employer: * Address: * Phone: * Job Title * Pay Rate * Dates of your employment: * Describe your job: * Reason for leaving: * plus1 Add minus1 Remove Education/ Skills: Last High School Name and Address: * Grades completed: Did you graduate? * College/Trade School Name and Address: Years Completed: Did you graduate? Courses Studied: College/Trade School Name and Address: Years Completed: Did you graduate? Courses Studied: Other courses, trade certificates or studies: Name and Address of Organization: Course Certification (if any): Dates of Attendance: plus1 Add minus1 Remove Professional References: Professional References: Please list 3 Name * Affiliation * Phone * Years Known * Professional References: Name * Affiliation * Phone * Years Known * Professional References: Name * Affiliation * Phone * Years Known * plus1 Add minus1 Remove Statement of Interest: Employment Requirements: Ability to work at a computer. Be on time for scheduled hours. Courteous customer service to all clients at all times. Able to lift 50 lbs unaided and safely. Able to work with dogs and cats. Ability to work with various personalities and get along with all staff members. Considerate of volunteers and respectful of their compassion. Ability to withstand loud noises, odors, animal hair, and dander. Physical ability to stand on hard floors for extended periods of time. Able to withstand the physical stress of bending and stooping continually. Able to follow direction given by supervisors. Initial here that you understand these requirements: * Please submit a Resume. * Drop a file here or click to upload Choose File Maximum file size: 4MB Please submit a Cover Letter. * Drop a file here or click to upload Choose File Maximum file size: 4MB IMPORTANTPLEASE READ THE FOLLOWING CONDITIONS OF EMPLOYMENTYour signature below indicates you have read and agree to the followingconditions:I certify that the information contained in this application is true and complete. Iunderstand that providing false or misleading information, misrepresentation orwillful omission of facts during the application or interview process may result inwithdrawal from consideration for employment or immediate discharge if alreadyhired, regardless of when discovered. I authorize Heart of the Valley, Inc. toinvestigate all statements in this application and to conduct a thoroughinvestigation of my past employment, education and job related activities. Iindemnify HOV against any liability which may result from conducting such aninvestigation. All employers, educational institutions and references listed arehereby authorized to give you any and all information regarding my employmentand character and are hereby released from any and all liability which may resultfrom furnishing such information.By signing the acknowledgement that I am 18 years of age or older and amphysically able to perform the duties mentioned above, I am also signing that Iunderstand and accept that Heart of the Valley, Inc. is a Drug Free Workplace. Iunderstand that as a condition of employment I may be asked to submit to aurinalysis or blood test at the expense of Heart of the Valley, Inc. This test maytest for drugs such as, but not limited to, cannabinoids, cocaine, opiates,amphetamines, phencyclidine, barbituates, methaqualone, benzodiazepines,methadone, propoxyphene, and any other substance illegal under federal or statelaw. The drug test will be performed by a reputable drug testing company orhospital. The results of the test will remain confidential and will not be disclosedto anyone other than you, Heart of the Valley, Inc., and the person and/or entityconducting the test. If your test results are positive for any of the drugsreferenced above, Heart of the Valley reserves the right to not hire you.Updated 11/2018I understand that personal property carried by me to and from Heart of the ValleyAnimal Shelter may be inspected by an authorized Heart of the Valleyrepresentative.I understand this application is not a contract of employment. Signature * Date * Submit If you are human, leave this field blank.
