Personal
Are you authorized to work in the United States?
Within the past 5 years, have you ever been convicted of a felony, or within the past two years
of any misdemeanor? (Do not include any traffic violations, juvenile offenses or military convictions, except by
general court martial. Conviction doesn’t automatically remove you from consideration for employment.)
*If the answer is yes, furnish details of conviction, offence, location, date and sentence.
Are you currently using illegal drugs?
Position desired:
Have you ever applied for work with us before
We are an equal employment opportunity employer in accordance with applicable local, state and
federal law.
Highest level of education
Graduate
(1) Employment History (most recent first)
Month – Year employed
Hourly Pay
Is this your present employer? (If yes, this employer will not be contacted without your permission)
(2) Employment History
Month – Year employed
Hourly Pay
(3) Employment History
Month – Year employed
Hourly Pay
May we have permission to contact:
Present Supervisor
Past Supervisors listed
References listed below
List business and professional references, other than relatives, who know you well.
CONDITIONS OF EMPLOYMENT AT ROCK BRIDGE ANIMAL HOSPITAL, PC
(Herein Referred To As “the Company”)
"I certify that the information on this and any other employment form is true to the best of my knowledge and belief. I fully
understand that any offer I may receive is contingent upon my passing a drug and alcohol test.
I agree to sign and comply with the Company Employee Agreement.
I authorize the Company to inquire of any and all persons, other than my present employer (unless I grant permission), as to my
character, ability and history (such as academic, credit and criminal) and as to statements contained within the employment application
and hereby release from all liability or damage the Company and those persons who provide such information to the Company.
Furthermore, I understand that misrepresentation or omission of facts in this application or any other employment form is cause for its
cancellation or for immediate termination of employment in the event I am subsequently employed by the Company.
I understand that, if an offer of employment is made, I must comply with the Immigration Reform and Control Act of 1986, as
amended, by submitting documents that verify my identity and authorization for employment in the United States.
I understand and acknowledge that acceptance of the employment application is not an express or implied promise by the Company to
offer employment to me. If I am subsequently employed by the Company, my employment may be terminated with or without cause
and with or without notice, at any time, at the option of either the Company or myself. This policy cannot be changed except by a
writing signed by myself and an officer of the Company."
