Jester Plaza Veterinary Clinic

1957 West T. C. Jester Blvd.
Houston, TX 77008

(713)869-0202

jesterplazavet.com

 

Jester Plaza Veterinary Clinic Employment Application Form

Position applying for:_______________________

 

Name: Last____________First____________Middle____________

Telephone: ____________ Alternate Phone: ____________

Email:_________________________

Address: Street_________________________ City____________ State _____  Zip_________

I am legally eligible for employment in the U.S.?                 

                Yes                  No

Available to work overtime if needed?

                 Yes                  No                                                   

Are You a Veteran or Currently in the Military?

            Yes            No                                                                       

Looking for Part time Position?    __________-__________ Hours per Week                   

Looking for Full time Position?    __________- __________ Hours per Week                  

Date you would be available to start? __________

Work weekends?        Yes         No

Are you willing to work Holidays?                Yes                        No

I give my permission for a background check and an employment reference check?        Yes        No

Specific days you can not work? ____________________________________________

EMPLOYMENT HISTORY STARTING WITH THE MOST RECENT

Employer Name and Address:

___________________________

___________________________

Supervisor:______________

Phone: _________________

Position Title: ____________

Duties: _________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Start date: ____________

End Date: ____________

Pay Rate:___________

Per: ____________

Reason for leaving:

______________________________

______________________________

Employer Name and Address:

___________________________

___________________________

Supervisor:____________

Phone: _________________

Position Title:____________

Duties: __________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

 ________________________________________________________

 ________________________________________________________

Start date: ____________

End Date: ____________

Pay Rate: ____________

Per: ____________

Reason for leaving:

______________________________

______________________________

Employer Name and Address:

___________________________

___________________________

 Supervisor:___________

Phone:_________________

Position Title:_____________

Duties: __________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Start date: ____________

End Date: ____________

Pray Rate: ___________

Per: __________

Reason for leaving: 

______________________________

______________________________

Employer Name and Address:

__________________________

___________________________

Supervisor: ___________

Phone: __________________

Position Title:_____________

Duties:  _______________________________________________________

________________________________________________________

________________________________________________________

 ________________________________________________________

 ________________________________________________________

________________________________________________________

Start date: ___________

End Date: ____________

Pay Rate: ___________

Per: __________

Reason for leaving:

______________________________

______________________________

Education

Level Achieved

Institution's Name

Years Completed

Field of study

Graduate/Degree

High School

_____________________________

 __________

__________________

     Yes      No 

College/University

_____________________________

 _________

__________________

     Yes     No

Trade/Other

_________________________________

 _________

__________________

     Yes    No

Skills

Other qualifications such as special skills, abilities or honors that should be considered:

___________________________________________________________________________________________________________

Types of software or other equipment in which you show mastery:

____________________________________________________________________________________________________________

Professional licenses, certifications or registrations:

____________________________________________________________________________________________________________

Additional skills, including supervision skills, other languages or information regarding your career:

____________________________________________________________________________________________________________

Typing Speed: ________________ per minute 

References

List three personal references whom are not relatives: 

Name: ____________________ Phone: ____________________

Occupation: ___________________ How long have you known this person? ____________________

 

Name: ____________________ Phone: ____________________

Occupation: ________________ How long have you known this person? ____________________

Name: ____________________ Phone: ____________________

Occupation: ________________ How long have you known this person? ____________________

List three professional references who you have previously worked with or for:

Name: ______________________     Phone: _______________

Occupation: ____________________ Position: ____________________

Name: _______________________    Phone: _______________

Occupation: ____________________ Position: ____________________

Name: _______________________    Phone: _______________

Occupation: ____________________ Position: ____________________

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked.  If you misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.

If necessary for employment, you may be required to supply a valid Texas driver's license, social security card or other forms of identification.  I understand and agree to the information shown above.

Signature of Applicant: ________________________  Date: ____________________