APPLYING FOR THE POSITION OF: Large Animal Vet Assistant
PERSONAL INFORMATION (** Required)
First Name: ** 
Last Name:**
Email
Street Address:
** 
Apt. No:
City:
**
State:
**
Zip Code:
**
County of Residence
**
Home Phone:
**

EDUCATION AND TRAINING (** Required)
High School
Name of School:
**
City:
**
State:
**
Years Attended or Year Graduated:

College
Name of School:
City:
State:
Years Attended or Year Graduated:
Degree Received:

Other
Name of School:
City:
State:
Years Attended or Year Graduated:
Degree Received:

ADDITIONAL PERSONAL INFORMATION (** Required)
Can you work evenings? **
Yes 
No
Can you work weekends? **
Yes 
No 
Have you ever been convicted of a felony? **
Yes 
No
(A conviction does not automatically disqualify. Give all the facts so that a decision can be made.)
 If Yes, explain below.

WORK HISTORY
Please list all employment and volunteer experience, including temporary and part-time, for at least the past five years.  Begin with your most recent employer.
Current Employer
Employer / Business Name:
May we contact your present employer?
Yes 
No
Dates employed: From:
    To:
(mm/yyyy format  Example. 05/2001)
Street Address:
City:
State:
Zip:
Phone Number:
Your Job Title:
Supervisor's Name:
Hours Work per Week:
Starting Salary:
per
Ending Salary:
per
Reason for leaving:
Duties:
Previous Employer
Employer / Business Name:
Dates employed: From:
    To:
(mm/yyyy format  Example. 05/2001)
Street Address:
City:
State:
Zip:
Phone Number:
Your Job Title:
Supervisor's Name:
Hours Work per Week:
Starting Salary:
per
Ending Salary:
per
Reason for leaving:
Duties:
Previous Employer
Employer / Business Name:
Dates employed: From:
    To:
(mm/yyyy format  Example. 05/2001)
Street Address:
City:
Zip:
Phone Number:
Your Job Title:
Supervisor's Name:
Hours Work per Week:
Starting Salary:
per
Ending Salary:
per
Reason for leaving:
Duties:

SKILLS
Please list any pertinent skills, knowledge, or experience that you may have.

CERTIFICATION

The Clover Times is authorized to verify any or all of the information contained on the application form. A false answer to any question(s) in this application may be grounds for non-selection, or for termination after you begin work.  All statements are subject to investigation including a check of your training and experience statements.

I hereby certify that all statements made in this application are true and I agree and understand that any misrepresentation, misstatement or falsification of facts may result in termination of employment.

I have read and understand the above: 
Yes (** Required)
Age Group you are in:  (** Required)



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