Fillable Printable CVS Application Form

CVS Application Form

CVS EMPLOYMENT APPLICATION

31310 Woodhaven Trail Cannon Falls, MN 55009

651-258-4050 fax 651-258-4051 email: Drtomwinter@cannonvet.com

TO APPLICANT: Thank you for your interest in Cannon Veterinary Services Ltd. and for

taking time to provide us with your background and work history. This information is necessary

to assist us in placing you in a position that best meets your qualifications.

PERSONAL Date_________, 20_________

Name________________________________ Birth date__________ Soc. Sec. # ________________________

Home#________________ Cell# ________________ Driver License#_________________________________

Present Address________________________________City___________________State_______Zip________

Permanent Address_____________________________City______________________State_______Zip______

Position applied for__________________________________________________________________________

Do you prefer? Full Time______ Part Time_______ If part time, days & hours________________________

Date available for work_____________________________ Salary desired_____________________________

How did you hear about this position? ___________________________________________________________

Have you been convicted of a felony within the last five years? Yes__ No__ If yes,

Explain___________________________________________________________________________________

Have you ever been suspended or discharged for cause? Yes__ No___ If yes,

Explain____________________________________________________________________________________

__________________________________________________________________________________________

MEDICAL HISTORY

Date of last health exam_________________________ Purpose_____________________________________

Are you willing to take a physical exam? Yes___ No___

How much time have you lost through illness in the past 2 years? ______________________________________

What was the reason? _______________________ _________________________________________________

Do you have any physical impairment? Yes___No___ If yes, Explain___________________________________

Have you ever been hospitalized? Yes___ No___ If yes, did it affect job performance?____________________

give dates & causes: _________________________________________________________________________

SPECIALIZED SKILLS AND EXPERIENCE

Explain your receptionist skills?

___________________________________________________________________________________________

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Explain your computer skills

____________________________________________________________________________________________

Can you type? How many words per minute?

____________________________________________________________________________________________

Explain your lab skills?

____________________________________________________________________________________________

How much experience have you had working with horses?

____________________________________________________________________________________________

How much experience have you had working with small animals?

____________________________________________________________________________________________

Describe other special skills, training, licensing, or certification which may be related to the position for which you

are applying?

____________________________________________________________________________________________

Would you consider yourself a motivated person?

____________________________________________________________________________________________

Describe the ideal Veterinary Practice

____________________________________________________________________________________________

How would you contribute to its success?

____________________________________________________________________________________________

On behalf of CVS, we would like to thank you for completing this Employment

Application. We appreciate dedicated people who strive to work as a valued team member

to advance the CVS practice and Veterinary Medicine for horses and pets.

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Employment History

(Begin with most recent)

Employer _____________________________ From ________________to _________________

Address ____________________________________________ Phone Number ______________

Supervisor _________________________Starting Salary _________ Ending Salary __________

Starting Position __________________ Ending Position _______________________________

Reason for Leaving _____________________________________________________________

Describe Responsibilities _________________________________________________________

______________________________________________________________________________

Employer _____________________________ From ________________to _________________

Address ____________________________________________ Phone Number ______________

Supervisor _________________________Starting Salary _________ Ending Salary __________

Starting Position __________________ Ending Position _______________________________

Reason for Leaving _____________________________________________________________

Describe Responsibilities _________________________________________________________

______________________________________________________________________________

Employer _____________________________ From ________________to ________________

Address ____________________________________________ Phone Number ______________

Supervisor _________________________Starting Salary _________ Ending Salary __________

Starting Position __________________ Ending Position ________________________________

Reason for Leaving _____________________________________________________________

Describe Responsibilities _________________________________________________________

______________________________________________________________________________

* May we contact the supervisors listed above? If not, please indicate which ones.

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Personal References

(Individuals who may be familiar with your abilities or work performance)

Name Occupation and Relationship Address Phone Number

______________ __________________________ __________________ _____________

Education Background

School Name Course of Study/Degree Dates Attended Graduated? Grade Average

_________________ ______________________ _______________ Y or N ___________

Additional Training or Professional Experience

______________________________________________________________________________

The information that I have furnished on this application, is true and complete. I understand that

if employed, false statements or omissions on this application shall be deemed sufficient cause

for dismissal. CVS is hereby authorized to make a full investigation of all information contained

in this application. You may contact former employers, supervisors or persons named with the

exception of those indicated above, concerning any and all information in their possession which

has a bearing on my suitability as an applicant.

Date ____________________ Signature ____________________________________________

For Office Use

Date:____________________ Accepted by:__________________________________________

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