Name *

First Name

Last Name

Phone *

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Would you work: *

Full-time

Part-time

Were you previously employed by this business? *

Yes

No

Are you over 18 years of age? *

Yes

No

If hired, can you furnish proof you are eligible to work in the United States? *

Yes

No

Phone number *

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Date employed from: *

MM

DD

YYYY

Date employed to: *

MM

DD

YYYY

Phone number

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Date employed from:

MM

DD

YYYY

Date employed to:

MM

DD

YYYY

Phone number

(###)

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Date employed from

MM

DD

YYYY

Date employed to

MM

DD

YYYY

Phone number

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Date employed from

MM

DD

YYYY

Date employed to

MM

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Do you authorize Viking Veterinary Care to obtain reference checks from previous employers? *

Yes

No

I understand that in order for me to be considered for employment with Viking Veterinary Care, I must submit to a pre-employment drug screening, which consists of a urine test to determine the presence of illegal drugs. I will be asked to submit to this test within 48 hours after a contingent job offer of employment has been extended to me. I understand that if the results of this test are positive, the contingent job offer will be withdrawn and I will not be considered further for employment at Viking Veterinary Care at this time or in the future. *

Yes

No

As this job position you are applying for involves handling cash and credit cards, access to medications and medical records, do you consent to a criminal background check? *

Yes

No

Can you read the job description for the position for which you are applying for? *

Yes

No

Are you able to perform all requirements of the position as outlined in the job description? *

Yes

No

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment with Viking Veterinary Care, I understand that false or misleading information in my application or interview may result in my release and or termination from any job with Viking Veterinary Care. *

Yes

No

Phone Number *

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Phone Number

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Phone Number

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