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All potential employees are evaluated without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related handicap or any other legally protected status.  \nPosition sought:   With organization:   How did you learn about the position?    \nName  Date    \nAddress  City  State  Zip   Home Phone   Office Phone  Other Phone   Email Address:   Social Security Number:  On what date would you be available for work?   Desired Wage/Salary $   Are you authorized to work in the U.S. without any restriction? [ ] Yes [ ] No  \nHave you ever been convicted of a crime or felony? [ ] Yes [ ] No  \nIf yes, please describe the circumstances:    \n____________________________________________________________________________________________________  \n____________________________________________________________________________________________________  \n(NOTE: a criminal conviction is not automatic grounds for rejection. However, lying about a criminal violation may become the basis for disqualification) .  \nHave you ever been involuntarily terminated or asked to resign from any position of employment? [ ] Yes [ ] No  \nIf yes, please describe the circumstances:    \n____________________________________________________________________________________________________  \n____________________________________________________________________________________________________  \nIf selected for employment, are you willing to submit to a pre-employment drug screening test? [ ] Yes [ ] No  \nIf selected for employment, are you willing to submit to a pre-employment medical test, if applicable? [ ] Yes [ ] No  \n\n| EDUCATION |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| School Name | Location | Years Attended\u003Cbr>From-to | Degree Received | Major |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\nOther training, certifications, or licenses held:    \n_______________________________________________________________________________________________________  \nList other information pertinent to the employment you are seeking:    \nEMPLOYMENT:  \n(Most recent first)  \n1. Employer  Job Title    \nDates Employed   Prior Position Held within Company (if any):   Address  City   State  Zip  Phone  Name of Supervisor   Job Title   Starting Salary  Ending Salary   \nDuties Performed:    \nSpecific skills acquired:    \nReason for Leaving:    \n2. Employer  Job Title    \nDates Employed   Prior Position Held within Company (if any):   Address  City   State  Zip  Phone  Name of Supervisor   Job Title    \nStarting Salary  Ending Salary   \nDuties Performed:    \n\n| Specific skills acquired:   |\n| --- |\n| Reason for Leaving:  \u003Cbr>3. Employer  Job Title  \u003Cbr>Dates Employed   Prior Position Held within Company (if any):   Address  City   State  Zip  Phone  Name of Supervisor   Job Title   Starting Salary  Ending Salary \u003Cbr>Duties Performed:   |\n| Specific skills acquired:   |\n\nReason for Leaving:    \n4. Employer  Job Title    \nDates Employed   Prior Position Held within Company (if any):   Address  City   State  Zip  Phone  Name of Supervisor   Job Title   Starting Salary  Ending Salary   \nDuties Performed:    \nSpecific skills acquired:    \nReason for Leaving:    \nOther employment: list any other employer you have worked with, prior to any of the jobs mentioned above:  \nJob title Employer’s name Supervisor’s name Date started Date ended  \n____________________ __________________ _________________ __________ __________  \n____________________ __________________ _________________ __________ __________  \n____________________ __________________ _________________ __________ __________  \nANNEX 1 : ACKNOWLEDGEMENT AND AUTHORIZATION  \nJob applied for:   Date:    \nPLEASE NOTE: this application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this t","cbCairzqGaSBkNKa","https://ap.wps.com/l/cbCairzqGaSBkNKa","pdf",567427,10,"English","# Job Application Information\n## Applicant Eligibility and Authorization\n## Education and Other Training\n## Employment History\n## Acknowledgement, Authorization, and Consent","[{\"question\":\"What eligibility and screening consents are required in the application?\",\"answer\":\"The form asks whether the applicant is authorized to work in the U.S. without restriction. If selected, applicants must indicate willingness to submit to pre-employment drug screening and, if applicable, a pre-employment medical test.\"},{\"question\":\"How does the form handle criminal conviction information and truthful answers?\",\"answer\":\"The form asks whether the applicant has ever been convicted of a crime or felony and requests circumstances if yes. It states that a criminal conviction is not automatic grounds for rejection, but lying about a criminal violation may be grounds for disqualification.\"},{\"question\":\"What authorizations does the applicant provide for investigations and background checks?\",\"answer\":\"The applicant certifies that answers are true and complete, authorizes investigation of statements in the application, and acknowledges an “at will” employment relationship unless changed in writing by an authorized executive. Annex 2 also requires consent for release of personal information for background checking, referencing applicable acts (FCRA and DPPA).\"}]","Care Veterinary Services - Job Application Form | PDF",1789823747]