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Please Answer All Questions. Attach a copy of your resume if one is available.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.
Name*
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Address
Are you able at the time of employment to submit verification of your legal right to work in the U.S.? (Verification and completion of Form I-9 must be submitted no later than three business days after date of hire.)
If under the age of 18, can you produce the necessary work certificate at the time of employment?
Type of employment desired?
Have you ever applied to this company before?
Within the past ten (10) years, have you been convicted of a felony? (Do not include convictions that were sealed, eradicated, erased, or expunged; convictions that resulted in referral to a diversion program; or marijuana-related convictions that are more than two (2) years old.)
NOTE
  • Criminal convictions will not automatically disqualify an applicant from a particular job. The East Greenbush Animal Hospital, LLC will consider the nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations.
  • An ex-offender who is denied employment may, upon written request, receive a statement of the reason(s) for denial within 30 days of the applicant’s request for such information.
Have you ever initiated an act of violence in the workplace?
High School Education
School Name and Location
Course of Study
Years of Completion
Graduation Year
 
College Education
School Name and Location
Course of Study
Years of Completion
Graduation Year
Degree/Major
 
Trade or Post College Education
School Name and Location
Course of Study
Years of Completion
Graduation Year
Degree/Major
 
Honors/Awards Received

Work Experience

Start with your present or most recent place of employment. You may include any verifiable work performed on a volunteer basis, internships, or military service.
Date Employed
From
To
May we contact you past Supervisor?

Date Employed
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To
May we contact you past Supervisor?

Date Employed
From
To
May we contact you past Supervisor?

Applicant Certification

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the East Greenbush Animal Hospital may now have, or may establish, a drug-free workplace or drug and /or alcohol testing program consistent with applicable federal, state, and local law. If the East Greenbush Animal Hospital has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the East Greenbush Animal Hospital policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the East Greenbush Animal Hospital policies and applicable federal, state, and local law.

If employed by the East Greenbush Animal Hospital, I understand and agree, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.

I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement.

I certify that all the information on this application, my resume, or any supporting documents is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

I understand that neither this application nor any communication by a management representative is intended to create or does create a contract of employment, offer, or promise of employment. I acknowledge that if hired by the East Greenbush Animal Hospital, employment is on an at-will basis. This means the East Greenbush Animal Hospital is free to terminate my employment at any time, with or without cause or advance notice, in accordance with state law, and acceptance of employment is not a contract of employment for any specified time. Similarly, I am free to terminate my employment with the company at any time for any reason. This at-will provision may be modified or waived only in a written agreement signed by an authorized representative of the East Greenbush Animal Hospital and me.

I agree to conform to the rules and regulations of the East Greenbush Animal Hospital, and I understand that the East Greenbush Animal Hospital has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will.

I authorize the East Greenbush Animal Hospital or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the East Greenbush Animal Hospital or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the East Greenbush Animal Hospital and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

I understand the East Greenbush Animal Hospital hires only individuals who are legally eligible to work in the United States.

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If the applicant is a minor, the foregoing release and consent must be signed by the applicant’s parent or legal guardian. Signature by the applicant’s parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the East Greenbush Animal Hospital, to the extent permitted by federal, state, and local law, can test the applicant for controlled substances, conduct inspections of property without notice, and communicate screen results to company personnel who need to know, the applicant, and the applicant’s legal guardian.
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