Crossroads Animal Emergency & Referral Center

EMPLOYMENT APPLICATION

11057 Rosecrans Avenue
Norwalk, California 90650
(562) 863-2522
18364 Beach Blvd.
Huntington Beach, CA 92648
(714) 794-6900

*Last Name:


*First Name:


Middle Name:


*Email Address:


*Street Address:


*Home Phone:


*City, State, Zip:


Business Phone:

*How many total years of experience do you have working in a veterinary clinic?   
You must have minimum 1-2 years experience to apply

*Have you ever applied for employment with us?      Yes      No


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


*Position Desired (Check the position you are applying for):


Tech Assistant

Vet Tech (Swing Shift Only)

Vet Tech (Overnight Only)

Vet Tech (Swing or Overnight Shift)

Lead Tech

Receptionist

Other:


*Pay Expected:

 

*Are you a Registered Veterinary Technician (RVT)?
Yes      No


*Would you work full-time?

Yes      No

*Part-time?

Yes      No

*Are you available to work overnight shifts?

Yes      No


What days and hours are you available 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:



*Do you type?
   
Yes   No    

How many WPM do you type?


Please list any other office machine(s) you can operate:


EDUCATION

School
Name and Location
Course of Study
# of Years Completed
Did you graduate?
Degree or Diploma
Graduate
Yes
No
College
Yes
No
Business/Trade/Technical
Yes
No
High School
Yes
No

EMPLOYMENT HISTORY

#1 Company Name:
Telephone:
City, State:
Employed - (month and year from/to):
Name of Supervisor:
Pay - Start/Hire:

Job Title:
Pay - Final:
Duties:
Reason for Leaving:

#2 Company Name:
Telephone:
City, State:
Employed - (month and year from/to):
Name of Supervisor:
Pay - Start/Hire:

Job Title:
Pay - Final:
Duties:
Reason for Leaving:

#3 Company Name:
Telephone:
City, State:
Employed - (month and year from/to):
Name of Supervisor:
Pay - Start/Hire:

Job Title:
Pay - Final:
Duties:
Reason for Leaving:

#4 Company Name:
Telephone:
City, State:
Employed - (month and year from/to):
Name of Supervisor:
Pay - Start/Hire:

Job Title:
Pay - Final:
Duties:
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:
DO NOT CONTACT: Reason:
DO NOT CONTACT: Reason:
DO NOT CONTACT: Reason:

Please add any additional comments on work experiences, 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: Address: Telephone:
Name: Occupation: Address: Telephone:
Name: Occupation: Address: 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.