Application for Employment

Personal Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name

First Last

Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Home Phone

Mobile Phone

Emergency Contact

Phone

Relationship

Are you eligible to work in the U.S?

Yes
No

Are you at least 18 years or older?

Yes
No

(If no, you may be required to provide authorization to work.)

Have you ever been terminated from employment or asked to resign by an employer?

Yes
No

If yes, please provide company names and details

Can you work any shift?

Yes
No

Can you work overtime, including weekends?

Yes
No

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes
No

Employment Desired

Position Desired

Please Specify

Date you can start

Rate desired $

FT or PT

No. of hrs/wk

Clinic?

Casselton
Fargo
Either

Are you currently employed?

Yes
No

If so, may we inquire of your present employer?

Yes
No

Education

High School Name

Did you graduate?

Yes
No

City and State

Diploma

Yes
No

GED

Yes
No

College/Univ/Trade

Did you graduate?

Yes
No

City and State

Degree Obtained

Add Additional

Yes
No

College/Univ/Trade

Did you graduate?

Yes
No

City and State

Degree Obtained

College/Univ/Trade

Did you graduate?

Yes
No

City and State

Degree Obtained

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. If additional space is needed, attach separate sheet of paper.

Name

Start Date

End Date

Address, City, State & Zip

Phone

Position

Supervisor

May we contact?

Yes
No

Wage

Duties

Reason for leaving?

Add Additional

Yes
No

Name

Start Date

End Date

Address, City, State & Zip

Phone

Position

Supervisor

May we contact?

Yes
No

Wage

Duties

Reason for leaving?

Add Additional

Yes
No

Name

Start Date

End Date

Address, City, State & Zip

Phone

Position

Supervisor

May we contact?

Yes
No

Wage

Duties

Reason for leaving?

Add Additional

Yes
No

Name

Start Date

End Date

Address, City, State & Zip

Phone

Position

Supervisor

May we contact?

Yes
No

Wage

Duties

Reason for leaving?

Skills/Certifications/Licensure

Are you professionally licensed in any state?

Yes
No

Which state(s)?

Expiration date(s)

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Computer Skills (please describe):

References

Give the names of two people (not related to you), whom you have known at least three (3) years.

First Reference

Name*

First Last

Phone*

Email*

Personal or Professional*

Personal
Professional

Years Known*

Second Reference

Name*

First Last

Phone*

Email*

Personal or Professional*

Personal
Professional

Years Known*

How did you hear about us?

Have you ever worked for this company before?

Yes
No

Explain

Do you know anyone who works for our company?

Yes
No

If yes, who?

Please read carefully before signing.

Casselton Veterinary Services, Inc. is an equal opportunity employer. Casselton Veterinary Services, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Casselton Veterinary Services, Inc. to hire me. If I am hired, I understand that either Casselton Veterinary Services, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Casselton Veterinary Services, Inc. has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Casselton Veterinary Services, Inc. true and complete information on this application. No requested information has been concealed. I authorize Casselton Veterinary Services, Inc. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Name*

Date*

Resume and Cover Letter

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE.

Personal Information

Employment Desired

Education

Employment History

Skills/Certifications/Licensure

References

First Reference

Second Reference

Please read carefully before signing.

Casselton Location

Fargo Location

Boarding And Grooming – Fargo

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