Employment Application Form

Applicant Information

Name *

First

Last

Email *

Date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Position Desired *

Minimum Salary / Desired Pay *

Phone Number *

Alternate Number

Employment Eligibility

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Are you a U.S. Citizen? *

Yes
No

If not, do you have legal right to work in the U.S.? *

Yes
No

Are you 17 years of age or older? *

Yes
No

If not, please specify age

Do you speak/read any language other than English? *

Yes
No

If yes, which one(s)

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Have you ever been convicted of a felony? *

Yes
No

Are there any criminal charges pending against you? *

Yes
No

Signature *

Clear Signature

Background Testing is an employment requirement. I understand that if I am offered a position, a background test may be required.

Signature *

Clear Signature

Drug-Free Screening is an employment requirement. I understand that if I am offered a position, drug screening may be required prior to employment.

Education

Please list all degrees or majors, name of school, and location of school.

Licenses / Certifications (type, number, issuing state if applicable)

Employment History

Please list your current and most recent past employment — include name and address of employer, all positions held, job duties, and your reason for leaving.

Additional Questions

Is any information relative to a change in name, assumed name, maiden name, or nickname necessary to check your work record or background.

Yes
No

If yes, please provide other names

Do you authorize us to contact your previous and present employers for references prior to employment?

Yes
No

Signature *

Clear Signature

Date *

If offered a position, will you have reliable transportation daily?

Yes
No

Are you able to lift more than 40 lbs if necessary?

Yes
No

If needed, would you be willing/able to do weekend and holiday boarding (feeding, cleaning, medicating animals)?

Yes
No

Is there anything else you would like us to know about you?

Upload Resume *

Click or drag a file to this area to upload.

Applicant's Affidavit

I certify that the information contained in this application is correct to the best of my knowledge. I authorize investigation of all matters contained in this application and agree that any misleading or false statements would be cause for rejection of this application or would be sufficient cause for dismissal after employment begins. I understand that employment is contingent upon the receipt of negative drug screening results, a background check, and satisfactory work references by Dillon Animal Hospital. *

I read and agree

Signature *

Clear Signature

Date *

Dillon

Email

Applicant Information

Employment Eligibility

Education

Employment History

Additional Questions

Applicant's Affidavit

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Dillon

Florence

Myrtle Beach