Application for Employment

An Equal Opportunity Employer

We do not discriminate on the basis of race, religion, national origin, color, sex, age, veteran status, or disability.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

Date / e-mail / Phone #
Social Security No. / Drivers License No.
Name

Last First Middle

Present address

No. Street City State Zip

Position applied for / Rate of pay expected $ / per hour

Would you work: Full Time Part Time

Specify days and hours if part-time:

Are there any days/times you cannot work?

Do you have a problem with working weekends?

List any friends or relatives working here

Name(s)

If you are offered a position, on what date will you be available for work?

Are there any other work experiences, skills, or qualifications that you feel would especially fit you for work here? Please add any additional comments you think are important for us to consider.

If you are applying for a job with minimum age requirements, you may be required to submit proof of age.

Are you 18 years of age or older? yes no

If hired, can you furnish proof you are eligible to work in the United States? yes no

Have you ever been convicted of a felony? yes no

A “yes” answer does not automatically disqualify you from employment since the nature of the offense, date, and the job for which you are applying will be considered.

If yes, please explain

Have you previously applied here? yes no

If yes, when?


Work History (begin with the most recent, list all pay employers, including military experience)

Name of Company / Phone number
Business Address / City / State
Type of Business / Immediate Supervisor
Start Date / End Date / Reason for termination
Exact job title / Earnings at hire / At termination
Description of duties
Name of Company / Phone number
Business Address / City / State
Type of Business / Immediate Supervisor
Start Date / End Date / Reason for termination
Exact job title / Earnings at hire / At termination
Description of duties
Name of Company / Phone number
Business Address / City / State
Type of Business / Immediate Supervisor
Start Date / End Date / Reason for termination
Exact job title / Earnings at hire / At termination
Description of duties
Name of Company / Phone number
Business Address / City / State
Type of Business / Immediate Supervisor
Start Date / End Date / Reason for termination
Exact job title / Earnings at hire / At termination
Description of duties

Affidavit

I certify that all information I have provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that the employer may request a background screen.

Signature / Date


Personal References (not former employers or relatives)

Name and occupation / Address / Phone number

Education Record

Name of School / Degree awarded / Grade Average / Honors
High School
College or University
Business, Trade, Correspondence or Night School
Other:
Do you type? yes no / WPM

Office machines and computers you know how to operate:

Do you have your own means of reliable transportation?

Have you ever received warnings from an employer or been terminated from a position

due to tardiness or absences? yes no If yes to either, please explain:

List two of your strengths (according to the position you are applying for):

List two of your weaknesses (according to the position you are applying for):

What veterinary-related goals have you set for yourself for the future?

What would you say are the most important aspects to running an exceptional animal hospital?

Why do you think you are the best candidate for this position?

Without stating your love and affection for animals, tell us why you want to work here.

For Nurse or Nurse Assistant Positions:

Please complete the following math problems:

A patient needs 500 milligrams of a drug. The drug is 1000 milligrams per milliliter.

How many milliliters will you give to the patient?

You need to give a patient/guest liquid medication. The bottle contains 100 milliliters of the medication and you need to administer 30% of what is in the bottle.

How many milliliters will you give to the patient?

The client’s bill is to receive a 10% discount. The total bill is currently $1,600.00

What is 10% of the total bill?
What would the new total be?

Please check the box next to each skill you are competent in

Obtaining a thorough patient history from clients

Obtaining vital signs (temp, pulse, respiration, MM/CRT)

Use of IDEXX Parvo, heartworm and FeLV/FIV tests

Prep of fecal floats and smears

Evaluation of blood smears (platelet count, WBC differential)

Blood transfusion principles – use of FFP, PRBSC’s, Oxyglobin, etc.

Clip and cleaning of wounds, basic bandaging principles

SQ, IM, IV injections (K-9 & feline)

Venipuncture (K-9 & feline cephalic, saphenous and jugular)

IV Catheter placement (K-9 & feline cephalic and saphenous)

IV Catheter placement (K-9 & feline jugular)

Urine collection via catheterization

Cystocentesis (K-9 & feline)

Placement of indwelling urinary catheters (K-9 & feline – male)

Placement of indwelling urinary catheters (K-9 & feline – female)

Operation of I-STAT machine

Operation of SCA2000 coagulation machine

Operation of Abaxis VetScan and CBC machine

Operation of fluid and syringe pumps

Radiography principles, protection and proper positioning

Operation and use of an autoclave

Proper cleaning and sterilization of surgical instruments

Prep and placement of nasal O2 and monitoring

ET intubation with and without laryngoscope (K-9 & feline)

Surgery principles including clip, prep and aseptic technique

Anesthetic principles, patient monitoring and IPPV

Operation of SPO2, ECG, BP and capnograph machines

Placement and use of an esophageal stethoscope

Post-operative patient recovery and monitoring

Ability to monitor intensive and critical care patients

Knowledge and ability to perform CPR (K-9 & feline)

Alerting clinician/other staff to changes in patient status

Knowledge of basic pharmacology

Knowledge of basic canine and feline behavior

Blood typing and cross-matching samples (K-9 & feline)

Compassionate canine handling and restraint

Compassionate feline handling and restraint

Ability to work with others using a teamwork philosophy

Asking others when unsure of something

Providing comfort/assurance to clients in an emergency

Ability to provide basic grief counseling to clients

Ability to maintain composure during emergency situations

Handle a multi-line phone system

(how many lines do you have experience with? lines)