First Name *

Last Name *

Street Address *

Apartment, suite, etc

City/Town *

State/Province *

ZIP/Postal Code *

Email Address: *

Phone Number: *

Position applying for: *

What type of work are you looking for? *

Would you be available to work overtime, if necessary?

Yes

If hired, what date can you start work? *

How did you hear about our company and this job opening? *

Have you ever applied to or worked for Lenity Vet Specialists before? *

If yes, when?

Why are you applying for work at Lenity Vet Specialists? *

If hired, would you have a reliable means of transportation to and from work? *

Yes

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) *

Yes

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Yes

If no, describe the functions that cannot be performed:

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)

Answer the following questions if you are applying for a professional position:

Are you licensed/certified for the job applied for?

Yes

Name of license/certification

Issuing State

License/certification number

Has your license/certification ever been revoked or suspended?

Yes

If yes, state reason(s), date of revocation or suspension, and date of reinstatement

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name

Occupation

Phone

Street Address

Apartment, suite, etc

City/Town

State/Province

ZIP/Postal Code

Country

Number of Years Acquainted

Add another reference?

Yes

Name

Occupation

Phone

Street Address

Apartment, suite, etc

City/Town

State/Province

ZIP/Postal Code

Country

Number of Years Acquainted

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