TLC PET MEDICAL CENTERS
EMPLOYMENT APPLICATION
TLC is always looking to recruit excellent staff members to join our team.
Positions include: Veterinarians; Technicians; Receptionists; Janitors.

TLC, Inc. is an Equal Opportunity Employer
PERSONAL
Last Name
First Name
Middle Initial
Social Security No
Address
Address 2
City
State
Zip
Home Phone No
Business Phone No
Permanent Address, if different from present address
If hired, can you provide proof that you are legally able to work in the United States?
How were you referred to us? Advertisement
Employee
Employment Agency
Walk-in
Other
Have you ever been convicted of a criminal offense, felony or misdemeanor, exclusive of any marijuana related conviction over two years old, any conviction for which the record has been judicially ordered sealed, expunged, or statutorily eradicated, any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed pursuant to Penal Code §1203.4? If yes, please state nature of offense(s), date(s), city and state and disposition. Note: An affirmative answer will not necessarily result in disqualification for employment:
List any relatives or friends employed by the Company
Relationship
Employment
Position Desired
Salary Desired
Check appropriate box for type of employment Full-time
Part-time
Temporary
What days and hours are you available for work?
Are you available for overtime?
When are you available to begin work?
Are you over 18 years of age?
If under 18, can you provide a work permit?
Are you able to perform the essential functions of the job for which you are applying?
If no, describe the functions that cannot be performed
(Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions)
Skills
Many of our customers do not speak English. Do you speak, write or understand any foreign language?
If yes, which language(s)
Operate Personal Computer?
Types of Software
List other office machines you can operate
Specific skills or training: What knowledge, special skills and/or individual capabilities do you have which especially prepare you for the position applied for?
Education
Type of School Name and Location of School No. of Years Completed Graduated?
  Yes  No		 Degree(s) or Diploma(s) Major Field(s) of Study
High School or Trade School
Business or Tech. School
Jr. College and/or University
Other Training (Explain)
Employment History
Experience: Please account for all employment within the last seven (7) years, beginning with your current or more recent employer. In addition, please indicate any other experience which you believe is relevant to the position for which you are applying (e.g., volunteer experience, military service, experience gained over seven (7) years prior, etc.) Attach an additional sheet if extra space is needed.
Answer the following questions if you are applying for a professional, licensed or certified position
Are you licensed/certified for the job applied for?
Name of license/certification
Issuing state
License/certification number
Has your license/certification ever been revoked or suspended?
If yes, explain
Positions Held
Company Name
Dates Employed From:       

    To:       
Starting Salary
Ending Salary
Job Title
Hours Worked From:  To: 
Street Address
City
State
Zip
Specific Job Duties

Telephone No
Supervisor
Is this your current employer?
Reason for leaving?
May we contact this employer?
What is the most important skill you demonstrated on the job?
Company Name
Dates Employed From:       

    To:       
Starting Salary
Ending Salary
Job Title
Hours Worked From:  To: 
Street Address
City
State
Zip
Specific Job Duties

Telephone No
Supervisor
Is this your current employer?
Reason for leaving?
May we contact this employer?
What is the most important skill you demonstrated on the job?
Company Name
Dates Employed From:       

    To:       
Starting Salary
Ending Salary
Job Title
Hours Worked From:  To: 
Street Address
City
State
Zip
Specific Job Duties

Telephone No
Supervisor
Is this your current employer?
Reason for leaving?
May we contact this employer?
What is the most important skill you demonstrated on the job?
Company Name
Dates Employed From:       

    To:       
Starting Salary
Ending Salary
Job Title
Hours Worked From:  To: 
Street Address
City
State
Zip
Specific Job Duties

Telephone No
Supervisor
Is this your current employer?
Reason for leaving?
May we contact this employer?
What is the most important skill you demonstrated on the job?
Company Name
Dates Employed From:       

    To:       
Starting Salary
Ending Salary
Job Title
Hours Worked From:  To: 
Street Address
City
State
Zip
Specific Job Duties

Telephone No
Supervisor
Is this your current employer?
Reason for leaving?
May we contact this employer?
What is the most important skill you demonstrated on the job?
Periods Of Unemployment
Please account for all periods of unemployment within the last seven (7) years, beginning with your most recent period of unemployment.
Dates Unemployed Reason for unemployment
From:    

   To:    
Dates Unemployed Reason for unemployment
From:    

   To:    
Dates Unemployed Reason for unemployment
From:    

   To:    
Dates Unemployed Reason for unemployment
From:    

   To:    
Military Service
Have you obtained any special skills or abilities as the result of service in the military
If yes, please describe
Personal References
Please list at least two (2) persons NOT related to you who have known you for at least five (5) years.
Person 1
Name :
Address :
Phone No :
Person 2
Name :
Address :
Phone No :
Security Code* Security Code
  1. The information that I have provided on this application is accurate to the best of my knowledge and
    may be verified by the Company or its agents.

  2. I authorize all the schools, persons and organizations named in this application to provide any relevant
    information in their possession or knowledge to the agents of the Company, for use in deciding whether
    or not to offer me employment and specifically waive any required written notification. I hereby release
    the Company, my former employers and all other persons from any and all claims, demands, or
    liabilities arising out of or in any way related to such inquiry or disclosure.

  3. I understand that the Company is committed to maintaining a drug and alcohol free work place.
    Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol
    screening. I further understand that if employed, I may be subject to such a drug and alcohol screening
    if the Company has reasonable suspicion to believe that I am under the influence of a drug or alcohol.
    My consent to submit to such a test is required as a condition of employment and my refusal to consent
    shall result in a refusal to hire or, if already employed, termination.

  4. I authorize the Company to obtain consumer reports from consumer reporting agencies for use in
    deciding whether or not to offer me employment. I understand that such reports may include
    information concerning my credit worthiness, credit standing, credit capacity, character, general
    reputation, personal characteristics, or mode of living. I understand that if I am denied employment
    based upon information contained in any credit report, I will be provided with the name, address, and
    telephone number of the consumer reporting agency, a copy of the report, and an explanation of my
    rights concerning it.

  5. I understand and agree that any misrepresentation or omission of facts in this application will be
    justification for refusal or termination of employment, regardless of the time elapsed before discovery.


  6. I understand and agree that the employment for which I am making application is, and is intended to
    be, at-will and such employment may be terminated at any time with or without cause, without prior
    notice, by either me or the Company. There will be no agreement, express or implied, between the
    Company and me for any specific period of employment, nor for continuing or long term employment,
    unless made in writing, signed by the Company’s President.

  7. I have placed my signature in the space provided below only after I have completed the entire form to
    the best of my ability and have carefully read the foregoing seven (7) statements.

  8. I understand that this application will no longer be active and will receive no further consideration once
    the position for which I am applying has been filled.