Employment Application Form | Lake City Animal Health & Wellness Center

Lake City Animal Health & Wellness Center

974 E. 300 N., Warsaw, IN 46582 574-267-8511

APPLICATION FOR EMPLOYMENT – AN EQUAL OPPORTUNITY EMPLOYER

Lake City Animal Clinic is an Equal Opportunity and At‐Will employer. Applicants are considered for positions without discrimination on the basis of race, color, creed, religion, national origin, gender, age, disability, veteran status, citizenship status or any other characteristic protected by federal, state, or local law.

SECTION I – PERSONAL INFORMATION: (Please make all answers complete and accurate.)

Date of Application(Required)

Email Address

Name(Required)

First Middle Last

Home Phone(Required)

Cell Phone(Required)

Other Phone(Required)

Current Street Address(Required)

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

Specific position you are applying for(Required)

Date Available(Required)

Schedule Desired(Required)

What are your minimum wage/salary requirements?(Required)

Currently on layoff or recall?(Required)

Yes

Do you have any relatives or friends currently employed by the Company?(Required)

Yes

Relatives or Friends currently employed by the Company(Required)

Name

Relationship(s)

How were you referred for employment?(Required)

Have you previously been employed by our company?(Required)

Yes

Have you signed any non‐competition agreements or do you have other obligations to a previous or current employer that restrict your ability to work for the Company?(Required)

Yes

Please explain(Required)

Have you ever been bonded?(Required)

Yes

Has bond ever been refused or cancelled?(Required)

Yes

SECTION II – EMPLOYMENT INFORMATION:

Are you at least 18 years of age?(Required)

Yes

If hired, can you present proof of your identity and legal right to work in the United States?(Required)

Yes

Have you been convicted of a crime?(Required)

Yes

Note: Conviction of a crime may not disqualify you from employment. Factors such as how long ago the conviction occurred, seriousness or nature of the violation, rehabilitation, and duties of the position you are applying for will be considered when making employment decisions. Do not include convictions that have been annulled, erased, expunged, vacated, set aside, sealed by a court, statutorily eradicated, impounded, pardoned, or referred to a diversion program.

Please Explain(Required)

SECTION III – EDUCATIONAL BACKGROUND, MILITARY SERVICE, & ADDITIONAL INFORMATION:

High School

Yes

NAME AND ADDRESS OF SCHOOL(Required)

COURSE OF STUDY(Required)

# OF YEARS ATTENDED(Required)

Please enter a number greater than or equal to 1.

DID YOU GRADUATE?(Required)

Yes

LIST DEGREE/DIPLOMA RECEIVED(Required)

College

Yes

NAME AND ADDRESS OF SCHOOL(Required)

COURSE OF STUDY(Required)

# OF YEARS ATTENDED(Required)

Please enter a number greater than or equal to 1.

DID YOU GRADUATE?(Required)

Yes

LIST DEGREE/DIPLOMA RECEIVED(Required)

Graduate

Yes

NAME AND ADDRESS OF SCHOOL(Required)

COURSE OF STUDY(Required)

# OF YEARS ATTENDED(Required)

Please enter a number greater than or equal to 1.

DID YOU GRADUATE?(Required)

Yes

LIST DEGREE/DIPLOMA RECEIVED(Required)

Technical, Business, or Vocational School

Yes

NAME AND ADDRESS OF SCHOOL(Required)

COURSE OF STUDY(Required)

# OF YEARS ATTENDED(Required)

Please enter a number greater than or equal to 1.

DID YOU GRADUATE?(Required)

Yes

LIST DEGREE/DIPLOMA RECEIVED(Required)

Answers to questions about Military Service are optional

Have you served in the U.S. Military?

Yes

Did your military service provide you with skills or training that will help you perform the position the position for which you are applying?

Yes

Please Explain

If you have any additional educational, vocational, and/or professional information, such as special areas of research or study, training, seminars, etc., please describe

List your familiarity with software or computer programs

SECTION IV – EMPLOYMENT DATA (Starting with your most recent employer first, please list employment history):

Current/Last Employer(Required)

Address(Required)

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

Dates Employed

From(Required)

To(Required)

Reason for leaving(Required)

Salary/Wages

Starting(Required)

Ending(Required)

Business Telephone(Required)

Position(s) Held(Required)

Name and Title of Immediate Supervisor(Required)

First

Duties(Required)

May we contact your current employer?(Required)

Yes

Previous Employer(Required)

First

Address(Required)

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

Dates Employed

From(Required)

To(Required)

Reason for leaving(Required)

Salary/Wages

Starting(Required)

Ending(Required)

Business Telephone(Required)

Position(s) Held(Required)

Name and Title of Immediate Supervisor(Required)

First

Duties(Required)

May we contact your current employer?(Required)

Yes

Previous Employer(Required)

Address(Required)

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

Dates Employed

From(Required)

To(Required)

Reason for leaving(Required)

Salary/Wages

Starting(Required)

Ending(Required)

Business Telephone(Required)

Position(s) Held(Required)

Name and Title of Immediate Supervisor(Required)

First

Duties(Required)

May we contact your current employer?(Required)

Yes

PROFESSIONAL POSITIONS ONLY(Required)

Please indicate professional memberships, certificates, or licenses held (exclude those indicating race, color, religion, national origin, gender, age, disability, labor organization affiliations or other protected characteristics under federal, state, or local law)

SECTION V – REFERENCES (Please provide the names, addresses, and telephone numbers of three employment references who are not related to you):

REFERENCES(Required)

Name

Address

Phone Number

SECTION VI ‐ ACKNOWLEDGEMENT & SIGNATURE:

Applicant Signature(Required)

Date of Application(Required)

*This application will only be considered for twelve months. If you have not been hired within twelve months of completing this application and you wish to continue to be considered for employment, you must complete another application.

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