Apply for a Job

Application.pdf You can download, print out, and fax this application form to (309)-663-8166 or you can fill out our online form.

Apply For A Job

First Name:
Last Name:
M. Initial:
Home Address:
Social Security #:
Phone #:
Alt. Phone #:
Date of Birth:
Today's Date:
Are you a citizen or alien authorized to work in the United States?	Yes
	No
Have you ever been convicted of a crime (excluding traffic violations)?:
If yes, please explain:
What position are you applying for?:
What skills or qualifications do you have for the position you are applying for?:
Do you have experience with computers?:
Education
School/Year/Graduated?
Grammar:
High School:
College:
Other:
Study?:
Previous Employment
List the last two companies you have worked for.
Company:
Address:
Phone:
Supervisor:
Date of Employment (from):
Date of Employment (to):
Reason for Leaving:

Company:
Address:
Phone:
Supervisor:
Date of Employment (from):
Date of Employment (to):
Reason for Leaving:
Military Services
Branch:
Rank:
Discharge:
Type of Discharge:
National Guard/Reserve?	Yes
	No
Reference
Name:
Address:
Phone #:
How long known?:

Name:
Address:
Phone #:
How long known?:
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Holidays
Terms & Conditions
I acknowledge that Fairway Knolls Veterinary Hospital is relying on the information given and I certify that the information in this form is true to the best of my ability. I authorize Fairway Knolls Veterinary Hospital to obtain information from any person named above, and I release all concerned from any liability in connection with obtaining and releasing such information.	I accept