Application for Employment - Vet In Palm City | Palm City Animal Medical Center

Personal Information

Name

First Last

MI

Home/Cell phone

Email Address*

Apt #

Address

Street Address City State / Province / Region ZIP / Postal Code

Position

Salary desired

Least Acceptable

1 Position desired

2 Position desired

Date available to start

Education

High School

Graduate?

Yes
No

Comments

College

Graduate?

Yes
No

Comments

Other

Graduate?

Yes
No

Comments

Employment History

Date From

Date To

Most Recent Employer Address & phone

Type of Business

Supervisor name

Position Held

Phone

Salary $

Reason for leaving

Major Duties/Achievements

Date From

Date To

Most Recent Employer Address & phone

Type of Business

Supervisor name

Position Held

Phone

Salary $

Reason for leaving

Major Duties/Achievements

Date From

Date To

Most Recent Employer Address & phone

Type of Business

Supervisor name

Position Held

Phone

Salary $

Reason for leaving

Major Duties/Achievements

Please give the following questions very serious thought. Your candid answers will help us counsel you on your career path.

What is most important to you in terms of your career?

Where so you see yourself in two years?

Rank in order of priority (“1” being highest)

Benefits	Money	Location	Advancement	Challenges	Security

Can this be achieved at current company?

Yes
No

Have you discussed this with your boss / supervisor?

Yes
No

What do you like best about your current position / employer?

What don’t you like?

How long have you been looking for another position?

What have you done to secure another position?

Under what circumstances could your present company retain you?

How did you hear about us?

Do you have proof of the right to work in the USA?

Yes
No

Vehicle

Yr.

Make

Model

How long have you lived at your current address?

US Military?

Yes
No

Branch

Rank

To

From

REFERENCES

Former Co-Workers who can comment on your performance and competence

Name	Position	Company	Phone #	Address

Name	Position	Company	Phone #	Address

Name	Position	Company	Phone #	Address

Any Additional Information

Driver License Info: State issued

License Number

Have you ever been convicted of a crime?

Yes
No

If you answer Yes, please give an explanation:

Are you now, or have you ever been on Probation and/or Parole?

Yes
No

If you answer Yes,, please give an explanation

NOTICE TO APPLICANTS

This notice should be included in any application for employment. It should also be posted in an appropriate and conspicuous location on your premises and be available in your personnel office for the inspection by the general public during regular business hours.

This form should be provided and completed by an applicant at the time of the employment application. PALM CITY ANIMAL CLINIC and SNIPS & SNOOZES (“The Company”) has established and maintains a drug-free workplace program. This drug-free workplace program is in conformity with Chapter 440.102, Florida Statutes, its implementing regulations, and Florida law.

As part of this program, offers of employment are expressly conditioned upon passing a drug test. In addition, employees of “The Company” may be subject to drug testing under those conditions outlined in “The Company’s” Drug and Alcohol Policy Statement.

For a person receiving a conditional offer of employment, failure of a drug test or refusal to submit to drug testing when required by “The Company” shall cancel or terminate any job offer. For an employee, failing a drug test or refusing to submit to a drug test will result in action against an employee up to and including termination of employment.

A person who receives a conditional offer of employment will have an opportunity to confidentially report to the Medical Review Officer (MRO) both before and after being tested regarding the use of prescription or nonprescription medications. Additionally, a job applicant shall receive a list of common medications which may alter or affect a drug test. A job applicant will also be given names, addresses and telephone numbers of local alcohol and drug rehabilitation programs.

Any person receiving a conditional offer of employment who fails a drug test may challenge or explain the result within five working days after written notification of the test result. A job applicant will also have an opportunity to request a retest at the job applicant’s expense. If a job applicant’s explanation or challenge is unsatisfactory, the job applicant may contest the drug test results pursuant to rules adopted by the Department of labor and Employment Security or the Florida Agency for Health Care Administration.

The job applicant also has the responsibility to notify the laboratory or clinic conducting the drug test of any administrative or civil action brought involving the drug test conducted by that laboratory or clinic.

The job applicant also has a right to consult the testing laboratory or clinic for technical information regarding prescription and non-prescription medication. In addition, each job applicant will be given a list, prior to administration of the drug tests, of the substances to be tested. All test results will remain confidential except as allowed by law. “The Company” will provide each job applicant with a copy of “The Company’s” Drug and Alcohol Abuse Policy Statement prior to administration of a drug test.

Nothing in this Notice will affect these rights provided in any collective bargaining agreement between “The Company” and its employees. Refusal to complete or sign this document will result in a withdrawal of any offer of employment.

Name of Company

Name of Applicant

Applicant’s Signature

Date

Witness (printed name & signature)

Date