Employment FormNameDatePosition Applying ForPlease write your goals for the position for which you are applyingPlease write out your understanding of the purpose of a Veterinary PracticePlease write a brief letter to a client who has an overdue account(Please do this even though you may not be handling financial matters in the performance of your job)Name and AddressName First Last EmailSocial Security NumberCurrent Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone NumberCell NumberFormer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Position DesiredWhat position are you applying for?Salary Expectations?Where did you hear about the job opportunity?Work ScheduleWhat type of Employment? Full Time Part Time Temporary When could you start?What Schedule are you available for? (Include a.m. or p.m.)Sunday (From/To)Monday (From/To)Tuesday (From/To)Wednesday (From/To)Thursday (From/To)Friday (From/To)Saturday (From/To)Are You Currently Employed? Yes No Are You Currently a Student? Yes No Employment HistoryList the most recent employer or last employer first. Include military service or any selfemployed or unemployment periods. You must account for the past 10 years or since completing school, whichever is shorter. Use additional pages if necessary.Present or Last EmployerCompanyAddressTelephone NumberDates Employed (From - To)Last SalaryLast Position HeldLast Supervisor’s NameBe Specific - Why did you leave?Be Specific - Liked most about job?Be Specific - Liked least about job?Past EmployerCompanyAddressTelephone NumberDates Employed (From - To)Last Position HeldLast Supervisor’s NameBe Specific - Why did you leave?Be Specific - Liked most about job?Be Specific - Liked least about job?Personal ReferencesGive names of 2 persons, not relatives or former CAMC employees, who you have known for 5 years or moreNameNameAddressAddressCity/State/ZipCity/State/ZipPhone NumberPhone NumberNumber of Years KnownNumber of Years KnownIn Case of Emergency, NotifyNamePhone NumberAddressWork/Cell NumberCity/State/ ZipConditions of EmploymentWe set high standards for our employees and require compliance with these standards as a condition of employment. You need to carefully consider what will be required before accepting a position with us. As an employee, you would be expected to comply in full. You need to know and understand that we will require you to: ! Meet performance standards of position Work hours as scheduled – report to work on time Take direction from supervisors, and execute that direction to the best of your ability Maintain a positive, enthusiastic attitude at all times. Be a cooperative member of our team. Train, as needed, to keep a high performance level on your job. Maintain a business-like, professional appearance (dress and grooming)Would you be able to comply with all requirements as listed? Yes No If “no”, or you have any concerns about being able to comply with any of these requirements, please explain:EducationName of High SchoolCity and StateGraduated? Yes No Last College AttendedCity and StateGraduated? Yes No Degree (if applicable)Do you have any other kind of training? (Please include seminars and workshops) Yes No If “yes”, what was it? Please explainHave you ever been convicted of a crime or a violation, other than a minor traffic violation in the past 7 years? Yes No If "Yes", Please list all convictions, starting date, nature of offense and where they occurred. (NOTE: A conviction will not automatically disqualify you from employment)Are you legally eligible to work in the United States? Yes No Document Number (if Applicable)Can you perform the essential functions of the job for which you have applied? Yes No What accommodations, if any, do you need to perform this work?Are you currently on any kind of medication that would affect your ability to perform this job? Yes No If “yes”, please give a brief descriptionAny additional comments or information, please write herePhoneThis field is for validation purposes and should be left unchanged.
