Employment Application - Rogue Equine & Companion Animal Clinic

Todays Date?*

Applicant Full Name*

First Middle Last

Are you eligible to work in the United States?*

Yes
No

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different, otherwise leave blank)

Street Address Address Line 2 City State ZIP Code

Mobile Phone Number*

Email

If you are under age 18, do you have an employment/age certificates?*

Yes - I am under age 18 and I DO have an employment/age certificate
No - I am under age 18 and I DO NOT an have employment/age certificate
Not Applicable

Have you been convicted of or pleaded no contest to a felony within the last five years?*

YES
NO

If you answered yes to the question above (felony), please explain below.

Position applying for - please write in?*

Desired hourly wage or salary?*

Days available to work: As a clinic/hospital, we operate 7 days per week. Are you able and available to work every day of the week?*

Yes
No

Days available to work: As a clinic/hospital, we operate 7 days per week. Are you able and available to work holidays if asked or needed?*

Yes
No

Hours available to work: As a clinic/hospital, we operate 24 hours per day. Are you able and available to work more than 8 hours per day and overnight?*

Yes
No

Schedule: Work schedule may vary and changes may occur on short notice. Do you have access to reliable transportation?*

Yes
No

Are you able to lift 50 lbs routinely and regularly?*

Yes
No

Are you able to jog horses in hand?*

Yes
No

If you are not able to lift 50 lbs, please explain below. Otherwise mark as N/A*

Are you able to work under hot climate conditions (over 100 degrees) or cold (below freezing)?*

Yes
No

Are you able to work under conditions of high or low humidity?*

Yes
No

If you answered no to any of the two climate questions above, please explain. Otherwise mark as N/A.*

First available date to start work?*

Education*

Please list most recent school (include city and state) and diploma/degree earned.

Please list your licenses, training, awards and relevant skills.*

Current or most recent employer?*

Do you authorize to contact if needed?*

Yes
No

Supervisor's Name

First Last

Supervisor's phone number

Position title?*

Responsibilities?*

Reason for leaving?*

Final two questions! In just a few words, what kind of group work environ would you find most enjoyable?*

Last one! In just a few words, what would you do to help create and encourage an enjoyable work experience?*

Consent*

I give consent to Rogue Equine Hospital Inc. and its principal to pull a "soft" credit report. By "clicking" or selecting this consent box I am in effect gving my consent.

Consent*

I give consent to Rogue Equine Hospital Inc. and its principal to run a criminal background check. By "clicking" or selecting this consent box I am in effect giving my consent.

Applicants Statement*

I agree to the below statement:

APPLICANT’S STATEMENT:
I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent within applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal and refusal of employment.

Date of signing*

Applicants Signature*

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Phone

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for compassionate, personalized, expert veterinary medical care
serving Southern Oregon and Northern California.

Employment Application Form - Secure