First Name: M.I. Last Name:

Address: City State: Zip:

Male Female    SSN

Home Phone: Work/Cell Phone:

Email Address: *REQUIRED

Position Applied For: Salary Desired:
Will you have transportation to and from work? Yes No
Do you have a drivers license? Yes No
Issued by the State of: DL#
Are you a U.S. citizen? Yes No
Can you provide documented proof of your eligibility for employment in the US? Yes No
Have you ever been convicted of a crime? Yes No
If yes, please explain below:

Previous Employment (list up to three)

1. Name of Employer:
Name of last supervisor: Phone Number:
Complete Address:
Dates of Employment: From: To:
    Salary: From: To:
Last job title:
Reason For leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

May we contact your employer? Yes No

2. Name of Employer:
Name of last supervisor: Phone Number:
Complete Address:
Dates of Employment: From: To:
    Salary: From: To:
Last job title:
Reason For leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

May we contact your employer? Yes No

3. Name of Employer:
Name of last supervisor: Phone Number:
Complete Address:
Dates of Employment: From: To:
    Salary: From: To:
Last job title:
Reason For leaving (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

May we contact your employer? Yes No

______________________________________________

Please list two references other than relative and previous employers:

Name:
Position:
Company:
Telephone:

Name:
Position:
Company:
Telephone:

Use this space to add any additional information necessary to describe your full qualifications for the position for which you are applying:

Applicant's Agreement & Certification

By signing below the applicant certifies that the information provided in this application is true in all respects. The applicant agrees that if information provided in this application or in a subsequent interview is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. The applicant also authorizes the use of any information provided in this application to verify statements made in the application and subsequent interview(s). The applicant's signature authorizes past employers, references and all others to answer questions regarding his/her ability, character, reputation and previous employment record. The applicant releases all such persons from any liability or damages on account of having provided such information.

It is understood that nothing contained in this application or in the granting of an interview constitutes a contract between Cherokee Animal Clinic, its owners or agents and the applicant for employment or benefit(s). No promises of employment are to be implied by the applicant nor are any such promises binding upon Cherokee Animal Clinic, its owners or agents unless made in writing. If an employment relationship is established either party has the right to terminate the relationship at any time unless otherwise stipulated by written contract. Policies and rules provided by Cherokee Animal Clinic that are not included in a written employment contract are subject to change at any time and are not conditions of employment.

This application will be kept on file for at least thirty (30) days from the date it is completed, after which time the applicant must reapply in accordance with established company procedures.

Signature of Applicant:      Date:
(By typing your name in this box, you acknowledge all the information provided on this application is true & correct to the best of your knowledge)

***Please fill out this form as completely as possible.
Once you have completed the following application, you can -
PRINT IT
And fax the application to us at 903-683-8135
or submit on-line below.