Animal Health Care Center

Employment Application

Animal Health Care Cneter is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief or disability.

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity within three (3) days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

If you are interested in employment opportunities, we are always welcoming new applications for all positions. Please Print Out this application and send it to the following address;

Animal HealthCare Center

504 Renton Center Way SW Ste. 3

Renton WA. 98057

Attn. Hospital Manager

Personal Data

___________________________ __________________ ______________________

First Name Middle Last

___________________________ __________________ ______________________

Street Address City State Zip Code

___________________________ __________________ ______________________

Home Telephone Number Social Security Number Today’s Date

___________________________

Daytime Telephone Number at which we may contact you

Are you 18 yrs of age or older? Yes____ No____

Have you ever been convicted of a crime? Yes___ No___

If “yes”, please explain:

_____________________________________________________________________________

Have you ever been convicted of a drug crime? Yes____ No____

If “yes”, please explain:

_____________________________________________________________________________

Position Preferences

For what position are you applying?_____________________________________

Wage desired: $__________ Schedule desired: Full Time Part Time

# of hours per week _______ Could you work overtime? Yes No

What date could you start work? _________________________________________

Education

High School

School Name: _______________________________________________________

City and State:_______________________________________________________

Degree or # of years Completed:_________________________________________

College

School Name : ______________________________________________________

City and State:______________________________________________________

Degree or # of years Completed:________________________________________

List any experiences you have had working with animals.

_____________________________________________________________________________

_____________________________________________________________________________

List any classes you have taken or experiences you have had which directly relate to the position you are applying for.____________________________________________________________

_____________________________________________________________________________

Previous Employment

List your current or most recent employment first. Include work related internships, military and volunteer work.

Current Employer:______________________________________________________________

City and State:_________________________________________________________________

Telephone Number:_____________________________________________________________

Supervisor’s Name and Title:______________________________________________________

Position Title:__________________________________________________________________

Reason for Leaving:_____________________________________________________________

Salary:_________ per Hour Week Month Year (circle one)

Dates of Employment: From________________ To:_________________

Mat we contact your Employer: Yes_______ No_______

Previous Employer:_____________________________________________________________

City and State:_________________________________________________________________

Telephone Number:_____________________________________________________________

Supervisor’s Name and Title:_____________________________________________________

Position Title:__________________________________________________________________

Reason for Leaving:_____________________________________________________________

Salary:_____________ per Hour Week Month Year (circle one)

Dates of Employment: From:_________ To:______________

May We Contact Your Employer: Yes_____ No_____

Please List Four Personal/ Professional References:

Name Title Company Phone Relationship

________________________ __________ ________ _______ _________________

________________________ __________ ________ _______ _________________

________________________ __________ ________ _______ _________________

________________________ __________ ________ _______ _________________

Releases and Applicant’s Signature

In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. Furthermore I understand that the company may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, criminal, civil and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I here by consent to obtaining the above information for Animal Hospital of Renton and/ or any of their agents. This authorization and consent shall be valid in original, fax, or copy form.

___________

Initials

All hiring and employment at Animal Health Care Center is at will. I understand this application is not an employment contract, nor can it be used to create one. Employment by Animal Health Care Center has no specific term and may be terminated by the employee or Animal Health Care Center with or without notice. I acknowledge that Animal Health Care Center has not made any promises or representations that differ from those contained in this paragraph.

I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with Animal Health Care Center and fail to provide this evidence it will result in the termination of my employment.

I release and agree to hold harmless any individual, company, business institution or government agency from all liability with regard to furnishing information to Animal Health Care Center. I agree to release and hold harmless Animal Health Care Center from all liability with respect to the receipt of such information.

I certify that the information I have furnished on this application form is true and complete. I understand that if any misrepresentation has been made by me verbally or in writing, any offer of employment made to me may be withdrawn or my subsequent employment with Animal Health Care Center may be terminated.

___________________________________________ _____________________

Applicant’s Signature Date