Crossroads Animal Emergency & Referral Center

EMPLOYMENT APPLICATION
11057 Rosecrans Avenue
Norwalk, California 90650
(562) 863-2522

*Last Name:
*First Name:
Middle Name:
*Email Address:

*Street Address:
*Home Phone:

*City, State, Zip:
Business Phone:

*Position(s) Desired:
*Pay Expected:

*This is an after-hours hospital, are you available to work overnights and holidays?
Yes      No


Are there certain days of the week or hours that you are unavailable to work? Be specific:

*Are you legally eligible for employment in the United States?
Yes      No     Comments:
List any friends or relatives working here:

*Have you ever been convicted of a crime in the past ten years,
excluding misdemeanors? Yes      No

If yes, please explain in detail:




*If hired, what date are you available to start?

DEGREES, LICENSES, CERTIFICATES
Degree
DVM degree from which school?
 Year:
License Licensed DVM in California?
Yes
No
Certificates Any additional licenses or certificates?

YOUR IDEAL JOB

Full-time
Part-time

Preferred Schedule:


Understanding that our vision is to deliver superior patient care and
customer service, what would make you the ideal fit at Crossroads?

 

Self-assessment—please rate yourself:

Emergency/critical care skills 1-10
Surgery experience and skills 1-10
Openness to change, adapt or improve 1-10
Image 1-10
Productivity 1-10
People skills 1-10

In addition to veterinarian duties, would you enjoy additional staff leadership or management responsibilities? 

Yes      No

 

If yes, check any that apply:

Assist with technician training
Develop technician training
Accompanying staff on visit to referring veterinary hospitals
Assisting with onsite CE lectures
Staff management
 

EMPLOYMENT HISTORY
#1 Company Name:
 Telephone:
City, State:
 Employed - (month and year from/to):
Name of Supervisor:
 Pay:
Job Title:
 Reason for Leaving:

#2 Company Name:
 Telephone:
City, State:
 Employed - (month and year from/to):
Name of Supervisor:
 Pay:
Job Title:
 Reason for Leaving:

#3 Company Name:
 Telephone:
City, State:
 Employed - (month and year from/to):
Name of Supervisor:
 Pay:
Job Title:
 Reason for Leaving:

We may contact the employers listed above unless you indicate those you do not want us to contact.

DO NOT CONTACT: Reason:

Please add any additional comments on specific work experience, management experience, skills, or qualifications that you feel would especially fit you for work here or you think may be important for us to consider in reviewing your application:

PERSONAL REFERENCES:
Name: Occupation: City, State: Telephone:
Name: Occupation: City, State: Telephone:
Name: Occupation: City, State: Telephone:


How did you hear about us - which website, magazine or personal referral?

 

By clicking the "submit application" button below, I agree that the information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal.

 

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.