Employment Application in Chino, CA | Chino Hills Animal Hospital

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Employment Application

An Equal Opportunity Employer

Please Print
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permanent Address (if different from present address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone*
Home Phone*
Employment Desired
Position applying for:*
Personal Information
Have you ever applied to or worked for Chino Hills Animal Hospital or Chino Hills Pet Resort be fore?*
- Yes
- No
If yes, when?*
Do you have any friends or relatives working for Chino Hills Animal Hospital or Chino Hills Pet Resort ?*
- Yes
- No
If yes, state name(s) and relationship:
Name*
First Last
Relationship*
Name
First Last
Relationship
Why are you applying for work at Chino Hills Animal Hospital ?

If hired, would you have a reliable means of transportation to and from work?*
- Yes
- No
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)
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 wher e 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*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
No. of years Completed*
Did you Graduate?*
- Yes
- No
Degree or Diploma*
College/University Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
No. of years Completed*
Did you Graduate?*
- Yes
- No
Degree or Diploma*
Vocational/Business Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
No. of years Completed*
Did you Graduate?*
- Yes
- No
Degree or Diploma*
Animal Care Training Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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*
First Last
Telephone No.*
Your Supervisor's Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates of Employment:
From*
MM slash DD slash YYYY
To*
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
First Last
T elephone No.
Type of Business
Your Supervisor's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates of Employment:
From
MM slash DD slash YYYY
To
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

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*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
No. of Years Acquainted*
Name
First Last
Telephone No.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation
No. of Years Acquainted
Name
First Last
Telephone No.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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 ma terial 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 referen ces 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 pers ons, 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 determinab le 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 an d the Company’s designated representat ive .*
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 enti tled to a copy of any such records even though I have checked the box below.*
*
- I waive receipt of a copy of any public r ecord described in the paragraph above
Date*
MM slash DD slash YYYY
Applicant’s Signature*
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Employment Application

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