9400 S. Union Ave  *  Tulsa, OK * 74132 * (918) 299-6050

Today's Date:

Name (First, Middle, Last):   Social Security No (Voluntary):

Current Address:    City:     State:    Zip:

Prior Address (incl. City, St & Zip):

Home Phone:   Work Phone:    Cell Phone:   E-Mail:

Alternative Contact Information:
                                                      Name                                           Address, City, State, Zip                                                                     Phone No.

Applicant Note:  This application form is intended for use in evaluating your qualifications for employment by Woodland West Pet Care Centers.  This is not an employment contract.  Please answer all appropriate questions completely and accurately.  False or misleading statements during the interview and on this form are grounds for terminating the application  process, or, if discovered after employment, terminating employment.  All qualified applicants will receive consideration without discrimination on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.  A felony conviction will not necessarily bar an applicant from employment.  Additional testing of job-related skills and for the presence of drugs in your body WILL be required prior to employment.  After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review.  Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

For which position are you applying:
Associate Veterinarian   Registered Veterinary Technician   Veterinary Assistant Customer Service Representative   Kennel Technician   Veterinary Practice Manager   Pet Resort Manager

What category would you prefer?  Full-time   Part-time   Temporary   Relief

For which schedules are you available?  Weekdays   Evenings   Nights Overtime   Shift Other

If hired, can you furnish proof your are eligible to work in the U.S.?  Yes No

JOB-RELATED SKILLS
(Note: Do not fill out any part of this section you believe to be non-job related.)
Only for jobs that require driving as part of your employment:
If the job requires, do you have the appropriate valid drivers license?  Yes No

Name on license DL# Type State of Issue

Have you had any moving violations:  No Yes   If yes, please describe:
 
SECURITY
 
Have you used any names other than given? No Yes If so, please list in comments below
Have you been convicted of a law violation in the past seven years? No Yes  (Conviction will not necessarily bar employment)
COMMENTS
 

 
PREVIOUS EMPLOYERS
 
Have you worked for Woodland West Pet Care Centers or an affiliated facility previously? Yes No
Facility Name:   Dates employed at this location: From To

Please Note: Your application will not be considered unless every question in this section is answered.  Since we will make every effort to contact precious employers, the correct telephone numbers of past employers are critical.  Ask for a phone book or call information if necessary.  FOR EMPLOYERS OUTSIDE THE USA, CURRENT FAX NUMBER IS MANDATORY


MOST RECENT EMPLOYER

Are you currently working for this employer: Yes No   Phone:   Fax:

If yes, may we contact: Yes No

Employed From: To:   Job Title: Supervisor Name:

Duties: 

Salary: $  Per  Reason for leaving:
 

 


SECOND MOST RECENT EMPLOYER

Are you currently working for this employer: Yes No   Phone:   Fax:

If yes, may we contact: Yes No

Employed From: To: Job Title: Supervisor Name:

Duties: 

Salary: $  Per  Reason for leaving:

 

 THIRD MOST RECENT EMPLOYER

Are you currently working for this employer: Yes No   Phone:   Fax:

If yes, may we contact: Yes No

Employed From: To:   Job Title: Supervisor Name:

Duties: 

Salary: $  Per  Reason for leaving:

 

REFERENCES
 

Name:

Address (w/city, state & zip)              Years Known / Relationship


Name:

Address (w/city, state & zip)              Years Known / Relationship


Name:

Address (w/city, state & zip)              Years Known / Relationship

 
EDUCATION
 
Please mark the highest high school grade completed: 7 8 9 10  11 12
If your school records are under a different name than listed on page 1, please enter that name:

HIGH SCHOOL:  Name: City/State:   Graduate?  Yes No   Degree?  Yes No

COLLEGE:  Name: City/State:   Graduate?  Yes No   Degree?  Yes No

OTHER:  Name: City/State:   Graduate?  Yes No   Degree?  Yes No

AFFIDAVIT, CONSENT AND RELEASE: PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITTING
 

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug-screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY A CORPORATE OFFICER OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY A CORPORATE OFFICER AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

I have read, understand, and by choosing SUBMIT, I consent to these statements.