Employment Application Form

Please fill out the form below

Step 1 of 4

All applicants are given equal consideration for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other status or orientation protected under applicable state, federal, or local law. Reasonable accommodation for the application process is available for applicants with disabilities.

This application will be kept on file for six months. Should you wish to be considered for employment after that time, please complete a new application. The application will be given every consideration, but it’s receipt does not imply that the applicant will be employed. Conditions of employment are stated at the end of this form. Please read carefully before you sign this application. Application must be completed in full, even if attaching a resumé.

Date: *

Name: *

Email: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long at present address: *

Social Security Number: *

Telephone *

If under 18, please list your age:

Position applied for: *

Salary desired: *

Days/hours available to work: *

How many hours can you work weekly? *

Can your work evenings? *

Can you work weekends? *

Employment desired: *

Full-time only
Part-time only
Full-time or part-time

When can you start work? *

Have you applied for employment here before? *

Yes
No

Can you, after employment, provide proof of eligibility or authorization to work in the United States? Proof of legal authorization to work in the United States will be required upon employment. *

Yes
No

Have you used other names (for example, maiden name)? If so, please provide:

Can you perform the job functions required by the position you are applying for? *

Is there anything that prevents your dependable and timely attendance at work:

High School:

Name and Address

Years Completed

Major and Degree

College:

Name and Address

Years Completed

Major and Degree

Bus. or Trade School:

Name and Address

Years Completed

Major and Degree

Professional School:

Name and Address

Years Completed

Major and Degree

Work Experience

Please list your work experience for the past five years beginning with your most recent job held. Attach additional sheets if necessary. Please complete even if you are providing a resume.

Name of employer:

Name of last supervisor:

Phone number:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Employment dates:

Pay or Salary:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, and advancements or promotion while you worked at this company.

Name of employer:

Name of last supervisor:

Phone number:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Employment dates:

Pay or Salary:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, and advancements or promotion while you worked at this company.

Name of employer:

Name of last supervisor:

Phone number:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Employment dates:

Pay or Salary:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, and advancements or promotion while you worked at this company.

Name of employer:

Name of last supervisor:

Phone number:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Employment dates:

Pay or Salary:

Reason for leaving (be specific):

List the jobs you held, duties performed, skills used or learned, and advancements or promotion while you worked at this company.

PLEASE READ CAREFULLY

APPLICANT STATEMENT

I certify that all information I have provided in this application is true and complete. I certify that any other documents and information that I have provided or will provide to the Company during the application process are true and correct. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize the investigation of any and all statements contained in this application, and authorize the Company to contact the persons and entities named in this application in order to provide any relevant information that, in the Company’s discretion, may be useful in the Company’s hiring decisions. I further authorize the persons and entities named in this application to respond fully and openly to Company’s inquiries. I release the Company and these persons and entities from all liability concerning such inquiries or the response to such inquiries.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing, as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.

I understand that, in connection with the routine processing of my employment application, the Company may request from a consumer reporting agency an investigative consumer report, including information as to my credit records, character, general reputation, personal characteristics, and mode of living, and I agree to sign and complete all disclosures, authorizations, and releases necessary to allow the Company to make such request.

I understand that this application or subsequent employment does not create a contract of employment for any definite period of time. If I am employed by the Company as a result of this process, I understand that I have been hired at the will of the Company and that my employment may be terminated by me or by the Company at any time, with or without case and with or without notice. I understand and agree that no promises of continued employment for any specified periods of time are binding or enforceable unless made in writing and signed by me and the authorized representative of the Company.

I understand that I will be expected to be physically capable of fulfilling the duties for the position in which I am applying and that if I will request a detailed job description if needed prior to my submission of this application.

I understand that the Company is a Tobacco Free employer. I understand that while employment is not dependent on the lack of tobacco usage, any use of tobacco during work hours is prohibited.

Name of applicant:

Signature of applicant:

Clear Signature

Date:

Thank you for completing this application and for your interest in our business.

Welcome to Lakeview Animal Hospital!

We proudly serve the pets of D'Iberville, Ocean Springs, Vancleave, Biloxi, St. Martin, Woolmarket, Latimer, and Gulfport.

Contact Us

Phone: 228-207-6864
Fax: 228-207-7119
Email: [email protected]

Visit Us

11505 Cinema Dr. Suite #12
D'Iberville, MS 39540
Click here for directions.

Hours

Mon - Fri: 8:00 am - 5:00 pm
Sat: 8:00 am - 12:00 pm
Sun: Closed

Have questions?

We're here to help. Please complete the form below and a member of our team will get back to you as quickly as possible. If this is an emergency situation, please call us at 228-207-6864.

Request an appointment online!

Complete our appointment request form from any device. You can also call us directly at 228-207-6864. We look forward to seeing you and your pet soon!

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Employment Application Form

Please fill out the form below

High School:

College:

Bus. or Trade School:

Professional School:

Please list two references other than relatives

Work Experience

PLEASE READ CAREFULLY

Welcome to Lakeview Animal Hospital!

We proudly serve the pets of D'Iberville, Ocean Springs, Vancleave, Biloxi, St. Martin, Woolmarket, Latimer, and Gulfport.

Contact Us

Visit Us

Hours

Have questions?

We're here to help. Please complete the form below and a member of our team will get back to you as quickly as possible. If this is an emergency situation, please call us at 228-207-6864.

Request an appointment online!