Employment Application in Andover, MA | Andover Animal Hospital

Step 1 of 2

Company Name*
Date*
Please Answer All Questions. Résumés Are Not A Substitute For A Completed Application.
We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.
Position Applied For*
Name*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How long have you lived there?*
Email (Optional)
Desired Salary / Hourly Rate*
If under the age of 18, can you produce the necessary work certificate at the time of employment?*
- Yes
- No
Type of Employment Desired?*
- Full-Time
- Part-Time
If Part-Time, specify hours
Are you willing to work overtime? (Yes / No)*
Date on which you can start work if hired*
Have you previously applied for employment with this Company? (Yes / No) If Yes, when and where did you apply?*
Have you ever been employed by this Company? (Yes / No) If Yes, provide dates of employment, location, and reason for separation from employment.*
If applicable, below list any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc.*

Education
High School*
School Name and Location (Address, City, State)
Graduate ( Yes or No)
# of Years Completed
Degree / Major
College*
School Name and Location (Address, City, State)
Course of Study
Graduate ( Yes or No)
# of Years Completed
Degree / Major
Business / Tech / Trade or Post College*
School Name and Location (Address, City, State)
Course of Study
Graduate ( Yes or No)
# of Years Completed
Degree / Major
Honors / Awards Received
Work Experience
Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer "see résumé."
Job #1
Employer
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Dates Employed (Start - End)
Job Title
Duties
Supervisor's Name
May we contact them? If no, why not?
Wages Start
Wages End
Reason for Leaving
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain
Job #2
Employer
Type of Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Dates Employed (Start - End)
Job Title
Duties
Supervisor's Name
May we contact them? If no, why not?
Wages Start
Wages End
Reason for Leaving
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain
Have you ever been terminated or asked to resign from any job? (Yes / No)*
If yes, how many times?
Has your employment ever been terminated by mutual agreement? (Yes / No)*
If yes, how many times?
Have you ever been given the choice to resign rather than be terminated? (Yes / No)*
If yes, how many times?
If you answered Yes to any of the above three questions, please explain the circumstances of each occasion.*
References (Work Related)
Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.
Reference #1*
Name
Position
Company
Work Relationship (Supervisor, co-worker, etc)
Telephone Number
Reference #2*
Name
Position
Company
Work Relationship (Supervisor, co-worker, etc)
Telephone Number
References (Personal)
Please list the names of personal references (not previous employers or relatives) who know you well that we may contact.
Reference #1*
Name
Occupation
Address
Telephone
Number of Years Known
Reference #2*
Name
Occupation
Address
Telephone
Number of Years Known
Applicant Certification
I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside. I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement.

I certify that all the information on this application, my résumé, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION IF HIRED THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME FOR ANY REASON WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT WRITTEN OR ORAL SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT—EXPRESS OR IMPLIED—WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.

I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company's intent to obtain "consumer reports." I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize the company to provide truthful information concerning my employment to future employers and hold the company harmless for providing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States.
Signature
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE.

DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION.
Applicant Signature*
Date*
MM slash DD slash YYYY
Signature Minor
If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.
Parent / Legal Guardian
Date
MM slash DD slash YYYY
Witness
Date
MM slash DD slash YYYY
If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.
Applicant Signature*
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR, POLYGRAPH, OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

I have read and understand the above statement.
Date*
MM slash DD slash YYYY
UNDER MASSACHUSETTS LAW, IT IS UNLAWFUL FOR AN EMPLOYER TO REQUIRE OR TO ADMINISTER A LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

FEDERAL AND/OR STATE LAW MAY PROHIBIT THE USE OF LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS WELL.

THIS APPLICATION MAY NOT BE SUFFICIENT FOR ALL INDUSTRIES OR APPROPRIATE FOR USE IN ALL LOCALITIES.
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Employment Application

Step 1 of 2

Please Answer All Questions. Résumés Are Not A Substitute For A Completed Application.

Education

Work Experience

Job #1

Job #2

References (Work Related)

References (Personal)

Applicant Certification

Signature

Signature Minor

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