Location * -Select-Main HospitalKenner ClinicLakeview ClinicWest Esplanade ClinicFreret ClinicMarigny Clinic Biographic Name Email Address Home Phone Alternate Phone Applying For Fulltime Parttime Position Reception Technician Assistant Kennel Attendant Bather Where Did You Here About Position Newspaper Online newspaper Job search engine Employee Education High School School Graduated Yes No Date GED College College Graduated Yes No Date Qualifications / Skills What Related Experiences Could You Contribute To Our Practice? Work Experience Work History: (Begin With Most Recent) Employer Dates (from-to) Name of Supervisor Address Phone Duties Salary Reasons for Leaving Hours per Week Employer Name of Supervisor Address Phone Duties Salary Reasons for Leaving Hours per Week Employer Dates (from-to) Name of Supervisor Address Phone Duties Salary Reasons for Leaving Hours per Week List of References Reference Address Phone Occupation Reference Address Phone Occupation Reference Address Phone Occupation More About You Please give us 5 attributes that you can consistently bring to our hospital that will make you indispensable. Have You Ever Worked For A Veterinarian Before? Yes No Would You Have Any Transportation Problems? Yes No Have You Ever Been Convicted Of A Felony? Yes No Have You Ever Been Discharged By An Employer? Yes No If yes, Please explain Employer Address Reason Pets Yes No Pet Names Would You Have Any Difficulty Lifting A 40-Pound Bag Of Dog Food? Yes No Explain What Salary & Fringe Benefits Would You Expect After 1 Year Of Employment? Why Do You Want To Work At Metairie Small Animal Hospital Do You Have Any Objections To Working Holidays Yes No Explain Are You Willing To Do Your Share Of Weekend Shifts Yes No Are There Any Days/Hours You Are Unable To Work Yes No Explain Why Should You Be Selected For The Next Available Open Position Terms This application does not constitute a written employment agreement. In the event that the applicant agrees to accept a position with the company, the applicant agrees that the employment relationship between Metairie Small Animal Hospital is an at-will relationship and that the employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or the employee. I certify that the information contained in this application is correct. If the company determines that any of the information submitted in this application is false, I shall be immediately disqualified from consideration for employment and/or discharged from employment in accordance with company policy. I hereby grant permission to the company to investigate the information contained in this application and release the company and any agents or other persons acting on behalf of the company from any and all liability relating to any investigation of the information contained in this application. Signature Signer Name *
