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Fillable Printable CVS Application Form

Fillable Printable CVS Application Form

CVS Application Form

CVS Application Form

1
CVS EMPLOYMENT APPLICATION
31310 Woodhaven Trail Cannon Falls, MN 55009
651-258-4050 fax 651-258-4051 email: [email protected]nnonvet.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 ___________
_________________ ______________________ _______________ Y or N ___________
_________________ ______________________ _______________ Y or N ___________
_________________ ______________________ _______________ 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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