ANIMAL HOSPITAL OF MONTGOMERY, LLC             272-2200

EMPLOYMENT APPLICATION

ANIMAL HOSPITAL OF MONTGOMERY

LOUIS N GOTTHELF, D.V.M.

3310 ATLANTA HIGHWAY

MONTGOMERY, AL  36109

334-272-2200  (Phone and FAX)                                                                                                                       DATE _______________

APPLICANT INFORMATION:

NAME:___________________________________________________________________
SOCIAL SECURITY NUMBER:__________________________________________________

LOCAL ADDRESS:__________________________________________________________

HOME PHONE:________________________ CELL PHONE:_________________________ WORK PHONE:_________________

APPLICATION FOR:

___Full –Time, Permanent  ___Part-Time, Permanent   ___Flexible Hours, On-Call    ___Weekend, Temporary    ___Part-Time, Temporary

EMPLOYMENT INTERESTS: 

______Vet Tech       ______Clerical       ______Kennel Help       ______Grooming       ______Groomer’s Assistant       ______Bather

EDUCATION:

High School:_________________________________________________________________  Graduated  (   ) Yes      (   ) No      (   ) GED

College:_________________________________________________________________ Graduated   (   ) Yes       (   ) No      (   ) Attending Now

LIST ANY SPECIAL ANIMAL CARE OR COMPUTER SKILLS YOU HAVE:

WORK HISTORY:  (List most recent employer first)

1.  Employer:____________________________________________________________
Phone_____________________ 
Address:_________________________________________________________________
From: __________________________To    ______________

Duties: ________________________________________________________________
Salary _____________ per hour___    per week___
Reason for Leaving:_______________________________________________________ 

2.  Employer:_____________________________________________________________
Phone_____________________        Address:_________________________________________________________________
From: ___________________________To_______________
   Duties:_________________________________________________________________
Salary_____________  per hour ___     per week ___ 
Reason for Leaving:____________________________________________________ 

REFERENCES: 
Full Name    Home or Business Address       Phone No                                     Occupation

1._____________________________________________________________________

2.______________________________________________________________________

3.______________________________________________________________________

             EMPLOYMENT APPLICATION QUESTIONNAIRE

Have you ever been arrested / or convicted of a felony?   (   )  Yes      (   )   No

If yes please explain:___________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

HAVE YOU EVER WORKED FOR A VETERINARIAN BEFORE?                    (   )   YES      (   )   NO

DO YOU SMOKE?                                                                                   (   )   YES      (   )   NO

DO YOU OWN ANY PETS YOURSELF?                                                     (   )   YES      (   )   NO

Please List: _________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

HAVE YOU EVER BEEN DISCHARGED BY AN EMPLOYER?       (   )   YES      (   )   NO

If yes, give:  Employer________________________________________________________________
Phone _________________
Address ________________________________________________________
Reason for Discharge  _________________________________________________________________________

WHAT SALARY & FRINGE BENEFITS WOULD YOU EXPECT AFTER 1 YEAR OF EMPLOYMENT?

_________________________________________________________________________

_________________________________________________________________________

WOULD YOU BE ABLE TO LIFT A 35-POUND DOG INTO A CAGE 4 FEET OFF THE GROUND? 
(   )   YES      (   )   NO

WHY DO YOU WANT TO WORK IN A VETERINARY CLINIC? _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

Would you be available to work holidays?  (   )   YES   (   )   NO                   
Are you willing to do your share of weekend pet care?   (   )   YES   (   )   NO

WHY SHOULD YOU BE CONSIDERED FOR THE NEXT AVAILABLE JOB POSITION? _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________