Employment Application Form in Chino, CA | Chino Hills Animal Hospital

An Equal Opportunity Employer

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Name
First Name Middle Last Name
Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State Zip
Permanent Address (if different from present address)
Street Address City State Zip
Business Phone
Home Phone
Cell Phone
Email
Employment Desired
Position applying for:
Employment Desired
Have you ever applied to or worked for Chino Hills Animal Hospital or Chino Hills Pet Resort before?
- Yea
- No
If yes, when?
Do you have any friends or relatives working for Chino Hills Animal Hospital or Chino Hills Pet Resort?
- Yea
- No
If yes, state name(s) and relationship:
Name
Relationship
Name
Relationship
Why are you applying for work at Chino Hills Animal Hospital?
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)
- Yes
- No
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?
- Yes
- No
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
- Yes
- No
If no, describe the functions that cannot be performed
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
Have you ever been convicted of a criminal offense (felony)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.)
- Yes
- No
If yes, state nature of the crime(s), when and where convicted, and disposition of the case.
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however, be considered.)
Education, Training and Experience
High School
Name Address City State Zip Country
No. of years Completed
Did you Graduate?
- Yes
- No
Degree or Diploma
College/ University
Name Address City State Zip Country
No. of years Completed
Did you Graduate?
- Yes
- No
Degree or Diploma
Vocational / Business
Name Address City State Zip Country
No. of years Completed
Did you Graduate?
- Yes
- No
Degree or Diploma
Animal Care Training
Name Address City State Zip Country
No. of years Completed
Did you Graduate?
- Yes
- No
Degree or Diploma
Employment History
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.
Name of Employer
Telephone No
Type of Business
Your Supervisor's Name
Address
Address & Street City State Zip
Dates of Employment: From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Hourly Wage: Starting
Ending
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Name of Employer
Telephone No.
Type of Business
Your Supervisor's Name
Address
Address & Street City State Zip
Dates of Employment: From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Hourly Wage: Starting
Ending
Your Position and Duties
Reason for Leaving
May we contact this employer for a reference?
- Yes
- No
Note: Attach additional page(s) if necessary.
References List below three persons not related to you who have knowledge of your work performance within the last three years.
Name
First Last
Telephone No.
Address
Address & Street City State Zip
Occupation
No. of Years Acquainted
Name
First Last
Telephone No.
Address
Address & Street City State Zip
Occupation
No. of Years Acquainted
Name
First Last
Telephone No.
Address
Address & Street City State Zip
Occupation
No. of Years Acquainted
Please Read Carefully, Initial Each Paragraph and Sign Below
- I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment, including medical history forms from pre-employment evaluation, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
- I hereby authorize, Chino Hills Animal Hospital to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
- I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative.
- Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
- Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
- I waive receipt of a copy of any public record described in the paragraph above
Date
Date Format: MM slash DD slash YYYY
Applicant’s Signature
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Employment Application Form

An Equal Opportunity Employer

Employment Desired

Employment Desired

Education, Training and Experience

Employment History

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