<p> Phone: 330-345-6063 Fax: 330-345-9670</p><p>Employment Application email: [email protected]</p><p>Applicant Information</p><p>Full Name: Date: Last First M.I.</p><p>Address: Street Address Apartment/Unit #</p><p>City State ZIP Code</p><p>Phone: Email: </p><p>Expected Hourly Date Available: Social Security No.: Pay:$</p><p>Position Applied for:</p><p>YES NO YES NO Are you a citizen of the United States? If no, are you authorized to work in the U.S.?</p><p>YES NO Have you ever worked for this company? If yes, when?</p><p>Full Time Part time </p><p>Position Desired: Technician Groomer Housekeeping Veterinary Assistant Hotel Manager Patient Care Coordinator Hotel Animal Care Attendant </p><p>Hours you are routinely available to work: Any hours needed Limited Hours: Explain______Mornings Evenings Weekends (Required for all positions)</p><p>Do you agree to a pre-employment drug screening? Yes No</p><p>Why do you want to work at Cleveland Road Animal Hospital? ______Education</p><p>High School: Address:</p><p>YES NO From: To: Did you graduate? Diploma::</p><p>College: Address:</p><p>YES NO From: To: Did you graduate? Degree:</p><p>Other: Address:</p><p>YES NO From: To: Did you graduate? Degree:</p><p>References Please list three professional references, no family or friends. </p><p>Full Name: Relationship: Company: Phone: Address:</p><p>Full Name: Relationship: Company: Phone: Address:</p><p>Full Name: Relationship: Company: Phone: Address:</p><p>Previous Employment Current Emplyer or Most Recent: Phone: Address: Supervisor:</p><p>Job Title: Starting Salary:$ Ending Salary:$</p><p>Responsibilities:</p><p>From: To: Reason for Leaving:</p><p>YES NO May we contact your previous supervisor for a reference?</p><p>Company: Phone: Address: Supervisor:</p><p>Job Title: Starting Salary:$ Ending Salary:$</p><p>Responsibilities:</p><p>From: To: Reason for Leaving:</p><p>YES NO May we contact your previous supervisor for a reference?</p><p>Company: Phone: Address: Supervisor:</p><p>Job Title: Starting Salary:$ Ending Salary:$</p><p>Responsibilities:</p><p>From: To: Reason for Leaving:</p><p>YES NO May we contact your previous supervisor for a reference?</p><p>Additional information Please describe any other relevant experience (Volunteer, animal related activities): ______</p><p>______</p><p>______</p><p>Describe your understanding of how customer service relates to the veterinary industry. ______</p><p>______</p><p>______</p><p>______</p><p>Define initiative and give an example of the last time you embodied it.</p><p>______</p><p>______</p><p>______</p><p>______I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. </p><p>Signature: Date:</p><p>Thank you for completing this application in detail and we will be in contact regarding the next step in the hiring process if you are selected for interview</p>