Employment Application Form | Belmont Animal Hospital

Name

First

Last

Date

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone(Required)

Email(Required)

Any Schedule Restrictions?(Required)

Position of Interest(Required)

Salary Requested(Required)

Were you ever employed here? If yes, when?(Required)

Educational Background

High School

City/State

Years Completed

Degree/Major

College/University

City/State

Years Completed

Degree/Major

Gratuate School

City/State

Years Completed

Degree/Major

Trade School

City/State

Years Completed

Degree/Major

Qualifications: List any applicable skills or certifications that you have received that may be of value to your employment:

Are you a US citizen and able to prove it?(Required)

Yes

If not, do you have the legal right to work in the US?(Required)

Yes

Are you 18 years or older?(Required)

Yes

If not, please specify age:

Do you speak or read any other launguages fluently besides english?(Required)

Yes

If yes, which one(s):

Have you been convicted of a felony crime?(Required)

Yes

Are there any criminal charges pending against you?(Required)

Yes

General Information

Do you have reliable transportation to and from work?(Required)

Yes

What do you plan to be doing in five years?(Required)

Are there any restrictions you have to your schedule that would interfere with your employment with us?(Required)

Yes

If yes, please explain.

Are you aware that working in a veterinary practice may require you to work extra hours or overtime?(Required)

Yes

Are you able to perform all of the duties listed in the job description?(Required)

Yes

Tell us about your greatest customer service achievement or your best example of helping a client or customer at work.(Required)

Tell us why you would like to work here, how you can help Belmont Animal Hospital, and how Belmont Animal Hospital can help you.(Required)

Employment History

Please fill out the below forms from most recent to least

Employment Dates

Employer's Name and Address

Position & Job Duties

Reason for Leaving

Wage/Salary

Employment Dates

Employer's Name and Address

Position & Job Duties

Reason for Leaving

Wage/Salary

Employment Dates

Employer's Name and Address

Position & Job Duties

Reason for Leaving

Wage/Salary

Is the information relative to change in name, use of an assumed name, maiden name, or nickname necessary to check you employment history? If yes, please explain:

Do you authorize us to contact your previous and/or present employer for reference prior to employment with this business?(Required)

Yes

Current Employer(Required)

Yes

Former Employers(Required)

Yes

Is there is anything else you would like us to know about you?

Signature

I certify that the information contained in this application is correct to the best of my knowledge. I
authorize investigation of all matters contained in this application and agree that any misleading or
false statements would be cause for rejection of this application or would be sufficient cause for
dismissal after employment begins. I understand that my continued employment will be based on
my satisfactory performance and the satisfactory completion of the Probationary Period of my
employment. I hereby authorize my past and present employers to furnish Lovers Lane Animal
Medical Center with their records of my employment.

Employment Application

Educational Background

General Information

Employment History

What's Next

Call Us or Schedule an Appointment Online

Meet with a Doctor for an Initial Exam

Put a Plan Together for Your Pet

Where family pets find loving care