CHESTNUT HILL CAT CLINIC EMPLOYMENT FORM


*Indicates a required field

Personal Information:
First Name*: Last Name*:
Are you 18 years of age or older?*    
Address 1*: Address 2:
City & State*: Zip*:
Contact Info:
Primary Phone*: Source of Referral*:
Secondary Phone:
Email Address*:
Employment Info:
Have you ever applied to Chestnut Hill Cat Clinic before?* What position are you interested in applying for?
If so, when?
Are you employed?*
If so, may we contact your employer?*
Do you have access to adequate transportation?* Are you legally eligible for employment in the U.S.?*
Salary at last job? Salary desired?
Date you can start?    

Have you ever been convicted of a crime?*

Chestnut Hill Cat Clinic realizes that certain criminal convictions have no reasonable relationship to the functions or responsibilities of the job in question. For this reason, a conviction record will not necessarily be a bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. Failure to disclose criminal convictions is considered falsification of this document and is grounds for termination.
Employment History - Employer 1:
Company Name:
Dates Employed: From: To:
Type of Business: Phone Number:
Address 1: Address 2:
City & State: Zip:
Name and Title of Supervisor: Your Job Title:
Description of duties: Reason(s) for leaving:
May we contact this employer?    
Employment History - Employer 2:
Company Name:
Dates Employed: From: To:
Type of Business: Phone Number:
Address 1: Address 2:
City & State: Zip:
Name and Title of Supervisor: Your Job Title:
Description of duties: Reason(s) for leaving:
May we contact this employer?    
Employment History - Employer 3:
Company Name:
Dates Employed: From: To:
Type of Business: Phone Number:
Address 1: Address 2:
City & State: Zip:
Name and Title of Supervisor: Your Job Title:
Description of duties: Reason(s) for leaving:
May we contact this employer?    
Education/Training - School 1:
Name: Location:
Major Area of
Study:		 Minor Area of Study:
Number of Years Attended: Degree Received:
Did you graduate?
Education/Training - School 2:
Name: Location:
Major Area of
Study:		 Minor Area of Study:
Number of Years Attended: Degree Received:
Did you graduate?
Education/Training - School 3:
Name: Location:
Major Area of
Study:		 Minor Area of Study:
Number of Years Attended: Degree Received:
Did you graduate?
Additional Educational Information:

List any academic honors, membership in academic/professional trade organizations, or participation in any outside activities or community organizations which you feel are significant. (Omit all information indicative of age, sex, race, religion, national origin, disability, color, creed, ancestry, marital status.)

List any computer skills you possess.
Agreement (please read carefully):

I hereby acknowledge notification that Chestnut Hill Cat Clinic may make such investigations and inquiries of my personal, employment, or other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and all persons contacted from all liability.

In the event of employment, I understand I am applying for employment which can be terminated at will by either myself or Chestnut Hill Cat Clinic and that nothing contained in any manual, brochure, or other Chestnut Hill Cat Clinic materials shall constitute an implied contract of employment. I also acknowledge that Chestnut Hill Cat Clinic may request previous employment information to evaluate my qualifications for employment. I understand that false or incomplete information in an application for employment may be grounds for dismissal and forfeiture of all related benefits. I understand that I am required to abide by all company rules and regulations.