Aurora Veterinary Clinic

305 Aurora Commons Circle
Aurora, OH 44202

(330)562-5100

www.auroravet.com

Employment Application Form

Name
First Name
Last Name
Address
Street Address
City
,
State / Province
Zip / Postal Code
Phone
Phone TypePhone Number
E-Mail Address :
Referred By:

Position desired:

Desired Salary

Date You can start :
Are you employed now?
Yes
No
If so, may we contact your current employer?
Yes
No
Have you ever applied to this company before?
Yes
No
If yes, when did you apply?

EDUCATION: Name & location of high school

Years Attended

Did you graduate?
Yes
No
Subjects studied

Name & location of college attended

Years attended

Did you graduate?
Yes
No
Subjects studied

Name & location of trade, business or correspondence school attended

Years attended

Did you graduate?
Yes
No
Subjects studied

Subject of special study or research work

Special training

Special skills

U.S. Military or Naval service

Rank

Former Employers: Name & Address of employer

Dates employed:

Former Employers: Name & Address of employer

Dates employed:

Former Employers: Name & Address of employer

Dates employed:

Former Employers: Name & Address of employer

Dates employed:

References: Please list reference name, address, business and years known.

References: Please list reference name, address, business and years known.

References: Please list reference name, address, business and years known.

Please read & sign electronically:
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no prepresentative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federl laws, the company will provide me with a written notice regarding the use of these reports and will also obtain a seperate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment." In compiance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.*
Electronic Signature
First Name
Last Name
Date :

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