PETCARE Animal Hospital 1173 West 10400 South (South Jordan Parkway) South Jordan UT 84095 PH: 801-302-9061 FAX: 801-302-5417 Email: petcareanimalhospital@comcast.net Scott Matheson DVM Diplomate, ABVP Darin Emch DVM Staff Member Employment Application Personal Information Name Of Applicant Home Home City Home ZIP Code Home Cell Email Are you 18 years of age or older? Yes No Are you a citizen of the United States? Yes No If not, do you have a legal work permit? Yes No Have you ever worked for us before? Yes No Have you ever pleaded "guilty", "no contest" or been convicted of a crime other than a non-violent misdemeanor? Yes No If Yes, then give details and dates Education High School Technical School Degree: Date: College Degree: Date: Other Degree: Date: Page 1 of 5 copyright 2007-2013 by PETCARE Animal Hospital 12/11/2013
Work Experience #1 (Most Recent) Work Experience #2 Work Experience #3 Work Experience #4 (Least Recent) Page 2 of 5 copyright 2007-2013 by PETCARE Animal Hospital 12/11/2013
Areas Of Special Interest, Knowledge, or Experience Please Circle As Appropriate Slight Moderate Extensive Anesthesia 1 2 3 4 5 Client / Receptionist Services 1 2 3 4 5 Computer skills 1 2 3 4 5 Preventative Health Care 1 2 3 4 5 Surgery, Soft Tissue 1 2 3 4 5 Surgery, Orthopedic 1 2 3 4 5 Radiology 1 2 3 4 5 Laboratory Services 1 2 3 4 5 Behavioral Counseling 1 2 3 4 5 Pharmacy 1 2 3 4 5 Patient Care 1 2 3 4 5 Alternative Medicine 1 2 3 4 5 Describe Any Special Skills or Qualifications: Community Service, Animal Welfare Work, Hobbies, or Pertinent Special Interests Page 3 of 5 copyright 2007-2013 by PETCARE Animal Hospital 12/11/2013
Basic Skills Test 1 Please circle the correctly spelled word in each group: vetranarian alleergy hospitaleization vetranary allergy hostilation veterinarian alergy hospitalization vetanarian algre hospitalizaeion vetnarian algery hostalization diarear surgiery consultation diarrhea surgry consoltation diarrhhea sergery consultition diarhea surgiry surgery 2 Please circle the letters of any abbreviation that may be found after the name of an animal doctor. Ph.D. M.D. D.V.M. D.D.S. V.M.D. 3 Make whatever corrections are necessary to make the following group of words an acceptable sentence. Because im hear today him and me can't go to the theater. 4 What does the word euthanasia mean? 5 The hospitalization fee for a dog is $18.00 per day. What would the charge be for an animal that has been in the hospital for 3 days? 3 days What would the charge be for 3 days plus surgery in the amount of $75.00? 3 days + hospitalization Page 4 of 5 copyright 2007-2013 by PETCARE Animal Hospital 12/11/2013
Position Sought / Information Position Applied For: Hours Desired or Available: Wages / Salary Desired: Date Available To Start: Certification To the best of my knowledge I acknowledge that the information contained in this application are true and correct. I authorize you to make such investigations and inquiries of my personal, employment, educational and other pertinent matters as may be necessary for an employment decision. I hereby release employers, schools, and individuals from any and all liability when responding to inquiries regarding this application. In the event of my employduring the application or interview process can result in discharge or other ment at PETCARE Animal Hospital, I understand that misleading or false information given action. Signature of Applicant: Date: PETCARE Animal Hospital is an equal opportunity employer. Thank you for your interest. Page 5 of 5 copyright 2007-2013 by PETCARE Animal Hospital 12/11/2013