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DOB *

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Email *

Date Available *

Social Security No *

Desired Pay Rate: $ *

per hour

Position Applying for *

Are you a citizen of the United States? *

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No

If no, are you authorized to work in the U.S.?

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No

Have you ever been convicted of a felony? *

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No

If yes, explain

Education

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Did you graduate? *

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College *

Did you graduate College? *

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Degree

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Did you graduate Other?

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References

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Relationship Reference 1 *

Company Reference 1 *

Phone Reference 1 *

Address Reference 1 *

Full Name Reference 2 *

Relationship Reference 2 *

Company Reference 2 *

Phone Reference 2 *

Address Reference 2 *

Full Name Reference 3 *

Relationship Reference 3 *

Company Reference 3 *

Phone Reference 3 *

Address Reference 3 *

Previous Employment

Company *

Company 1

Phone *

Company 1

Address *

Company 1

Supervisor *

Company 1

Job Title *

Company 1

Starting Pay Rate: $ *

Company 1

Ending Pay Rate: $ *

Company 1

Responsibilities *

Company 1

From Date *

Company 1

To Date *

Company 1

Reason for leaving *

Company 1

May we contact your previous supervisor for a reference? *

Yes
No

Company 1

Company *

Company 2

Phone *

Company 2

Address *

Company 2

Supervisor *

Company 2

Job Title *

Company 2

Starting Pay Rate: $ *

Company 2

Ending Pay Rate: $ *

Company 2

Responsibilities *

Company 2

From Date *

Company 2

To Date *

Company 2

Reason for leaving *

Company 2

May we contact your previous supervisor for a reference? *

Yes
No

Company 2

Company *

Company 3

Phone *

Company 3

Address *

Company 3

Supervisor *

Company 3

Job Title *

Company 3

Starting Pay Rate: $ *

Company 3

Ending Pay Rate: $ *

Company 3

Responsibilities *

Company 3

From Date *

Company 3

To Date *

Company 3

Reason for leaving *

Company 3

May we contact your previous supervisor for a reference? *

Yes
No

Company 3

Military Service

Were you/are you in the Military? *

Yes
No

Branch of service

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To Date

Rank at discharge

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If other than honorable, please explain

Pre-Employment Drug Testing Consent and Release Form

I ________________________ hereby consent to submit to urinalysis and/or other tests as shall be determined by Veterinary Orthopedic and Vision Center in the selection process of applicants for employment, for the purpose of determining the drug content thereof. *

I Understand

Pre-Employment Background Check and Consent and Release Form

I, __________________ hereby authorize Veterinary Orthopedic & Vision Center (the “Company”) of 2547 John Hawkins Parkway, Suite 103, Hoover, Alabama 35244, and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. An emailed signed copy or digitally signed copy of this consent shall be considered as valid as the original consent. I hereby consent to the Company’s verification of all the information provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copies of records pertaining to this information. I hereby authorize and agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answer or statements, or misrepresentation by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed. *

I Understand

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. *

I Understand

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Pre-Employment Drug Testing Consent and Release Form

Pre-Employment Background Check and Consent and Release Form

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