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Name: FMA Animal Hospital
Address: 4755 Rainbow Blvd, Westwood, KS, 66205, United States
Telephone: 913-262-1600
Price range: $

Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and/or interview process should contact a representative of our Human Resource Department.

Positions(s) applied for *

Date of application *

Name *

Address *

Address Line 1

City

State

Zip Code

Telephone *

Email *

If you are under 18, can you furnish a work permit? *

Have you ever been employed here before? *

Are you legally eligible for employment in this country? *

Date available for work *

Type of work desired *

Full-time
Part-time

Are you able to meet the attendance requirements of the position? *

Have you been convicted of a crime in the last ten (10) years? *

Such conviction may be relevant if job-related, and may not bar you from employment.

Employment History

List your last three (3) employers with the most recent listed first.

From *

To *

Employer *

Telephone *

Job Title *

Employer Address *

Address Line 1

City

State

Zip Code

Supervisor *

Summarize the nature of work performed and job responsibilities *

Reason for leaving *

Hourly Rate/Salary

Start $ *

Final $ *

From *

To *

Employer *

Telephone *

Job Title *

Employer Address *

Address Line 1

City

State

Zip Code

Supervisor *

Summarize the nature of work performed and job responsibilities *

Reason for leaving *

Hourly Rate/Salary

Start $ *

Final $ *

From *

To *

Employer *

Telephone *

Job Title *

Employer Address *

Address Line 1

City

State

Zip Code

Supervisor *

Summarize the nature of work performed and job responsibilities *

Reason for leaving *

Hourly Rate/Salary

Start $ *

Final $ *

Skills and Qualifications

Summarize any training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform job-related functions for the position which you are applying *

Educational Background (If Job Related)

High School

Year Completed

Did you graduate?

College

Year Completed

Did you graduate?

Course of Study

Other Education

Year Completed

Did you graduate?

Course of Study

References

Name *

Telephone *

Years known *

Name *

Telephone *

Years known *

Name *

Telephone *

Years known *

I hereby certify that the information I have entered on this form is correct to the best of my knowledge. I further understand that any false, inaccurate or omitted information given to this employer as a part of the hiring process is grounds for immediate termination no matter when such is discovered.

I give the employer the right to examine any and all criminal records, arrests, credit, and workers compensation records on file in the counties in the State of Kansas or any other state. In doing so, I understand that I am waiving my right of confidentiality. I give the employer the right to make a thorough investigation of my past employment activities concerning my services, character and conduct. I release from all liability any persons, companies, and corporations supplying such information.

This employer is an Equal Opportunity Employer. Our policy is to consider all applicants for employment based on their qualifications and our current job vacancies.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of this person's need for an accommodation that would be required by the ADA. I have been informed of the physical requirements for the position for which I am applying and I can perform the physical requirements of the position.

Signature of Applicant *

Date *