Please note: Application must be completed by applicant and must be handwritten. Be sure to sign and date the application. Applicant Name: Date:

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1 APPLICATION FOR EMPLOYMENT Please note: Application must be completed by applicant and must be handwritten. Be sure to sign and date the application. Applicant Name: Date: Position applying for: Type of employment desired: Full-time Part-time Seasonal Date you will be available to start work: Personal Information Home : Home phone: Cell phone: address: Are you at least 18 years of age? Yes No Are you legally eligible for employment in this country? Yes No Do you have reliable transportation to work? Yes, private Yes, public No Are you available to work between 7am and 7pm on weekdays? Yes (Technicians only) Are you available to work on Saturday mornings? Yes No No (Technicians only) Are you willing to be called in during an evening or weekend for emergency surgery, on an occasional basis? Yes No

2 Employment History Please provide employment information for your past three employers, starting with the most recent. If you have pertinent job experience beyond these three employers, please use the section marked Additional Employer. If you have adequately summarized your job duties on a resume that you have previously submitted to us or attached to this application, you may write see resume in the Summary of duties sections. However, you must fill out all other requested information for each employer here. 1. (City, State is sufficient if local) 2.

3 Employment History (cont d) 3. Additional Employer

4 Education TYPE OF SCHOOL NAME OF SCHOOL YEAR COMPLETED DEGREE High School College Other Post-High School Other Skills and Qualifications Summarize any other training, continuing education, computer knowledge, licenses, and certificates that you believe to be relevant to this position: Applicant Statement I certify that all information I have provided in order to apply for and secure work with Animal Surgical Clinic of Seattle (hereafter, ASCS) is true, complete and correct. I expressly authorize (without reservation), ASCS, its representatives, employees or agents to contact and obtain information from all references (personal & professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I also understand that ASCS will perform a background check. I hereby waive any and all rights and claims I may have regarding ASCS, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that ASCS does not unlawfully discriminate in employment and that no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that this application does not constitute an agreement or contract for employment with ASCS for any specified period or definite duration. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form on my hire date. I understand that a negative drug test result is required prior to employment in order to comply with ASCS s drugfree workplace program. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any manner will be sufficient cause to cancel further consideration of this application, or to immediately discharge me from service with ASCS, whenever it is discovered.

5 I understand that this is a drug-free and smoke-free workplace and consent to compliance with this policy as a condition of employment. Do not sign until you have read the above applicant statement. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Applicant signature: Date:

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