Application for Employment

2504 Mall Drive Eau Claire, WI 54701 715-835-5011

Application for Employment
Please complete the form below to apply for a position with us.

Personal Data

* Indicates required field

Name *

First

Last

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

Applying for Position *

Start Date *

Number of hours per week *

Number of days per week *

General Employment History
Begin with current or last job. Include military service assignments. If you include volunteer activities, you may exclude organizations that indicate race, color, religion, national origin, disability or other protected status.

Employer *

Address *

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Line 2

City

State

Zip Code

Country

Phone Number *

Job Title *

From - To *

Duties *

Hourly wage/Salary *

Start/Final Wage *

Employer *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Job Title *

From - To *

Duties *

Hourly wage/Salary *

Start/Final Wage *

Employer *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Job Title *

From - To *

Duties *

Hourly wage/Salary *

Start/Final Wage *

Upload Resume *

Max file size: 20MB

Education

Years completed *

High School & Location *

Diploma/Degree *

Studies *

Trade/Professional School & Location *

Diploma/Degree *

Studies *

College/University & Location *

Diploma/Degree *

Studies *

Specialized Training, Apprenticeship, Extracurricular Activities (honors, awards) *

Special Job-Related Skills and Qualifications from Employment or Other Experience *

Professional, Trade, Business, or Civic Organizations/Offices (You may exclude organizations that indicate race, color, religion, national origin, disability, or other protected status. *

Personal

If under 18 years of age, can you provide proof of eligibility to work? *

Have you ever applied to us before? *

Have you ever been employed with us before? *

Are you presently employed? *

If yes, may we contact your employer? *

Do you have a relative or friend employed with us? *

If yes, who? *

Have you ever been convicted of a crime (other than a traffic violation)? Conviction will not necessarily disqualify you from employment *

If yes, please explain. *

On what date will you be available for work? *

Hourly wage desired *

References other than relatives
Providing this information means that you give this organization permission to contact the reference listed.

1. Name, Address, Telephone Number *

2. Name, Address, Telephone Number *

3. Name, Address, Telephone Number *

Applicant's Acknowledgement
This application shall be considered active for no more than 45 days. After that time, applications will be required to submit a completed application. The applicant understands that neither this document nor any offer of employment from this employer constitutes an employment contract unless a specific document is executed in writing by the employer and the employment.
I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision. In the event I am employed, I understand that any false or misleading information I knowingly provided in my application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me. I understand that nothing in this application, or in any prior or subsequent written oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by the Eau Claire Animal Hospital, Inc., my employment will be "at-will," for an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of the Eau Claire Animal Hospital, Inc. or myself. I understand that I have the right to end my employment at any time and that the Eau Claire Animal Hospital, Inc. retains the same right. I also understand that no one has the authority to enter into any contract, agreement, or modification of the foregoing unless such contract, agreement, or modification is in writing and signed by Jayne Munkwitz.

Signature *

First

Last

Date submitted *

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