Employment Application

Broad Ripple Animal Clinic, Broad Ripple Animal Wellness Center, Broad Ripple Veterinary Management Solutions, and Bark Tutor School for Dogs are Equal Opportunity Employers

Full Name * First Last
Email *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

If you are a student, please list your local address.
Preferred Phone * - (###) - ### ####
Alternate Phone - (###) - ### ####
Are you legally eligible for employment in the US? * Yes No
Are you 18 years or older? * Yes No
Position Desired * Veterinarian (DVM) Registered Veterinary Technician (RVT) Client-Patient Assistant (Dual role acting as a Client Service Representative and Exam Room Veterinary Assistant) Veterinary Ward Assistant Dog Trainer Childcare Provider Clerical Assistant
Date you can start * / MM / DD YYYY
Hourly Rate Desired * $ . Dollars Cents
Ever worked in a veterinary hospital before? * Yes No
If yes, where?

If you answered "yes" to having worked in a veterinary hosiptal before, please let us know the name of the hospital.
Desired Status * Full-time Part-time
Please list the hours you are available to work (be specific) *
Highest Level of Completed Education High School Graduate G.E.D. Some College Associate Degree Bachelor Degree Graduate Degree
If you are still attending high school, you can skip this question.
Have you achieved certification or specialized training in any area? If so, please describe (be specific):
List the total number of employers you've had in the past 5 years: *
Upload your resume
Former Employers

Please complete the following information for your three most recent jobs. Please fill-in as much information as possible.
Name of Present or Most Recent Employer
Your Position

Please list your job title, or a description of the work you performed for this employer
Present or Most Recent Employer's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Employer's Phone - (###) - ### ####
Name of Supervisor First Last
Please list the name of the person who was your immediate supervisor
May we contact your Supervisor? Yes No
Starting Date / MM / DD YYYY
Leaving Date / MM / DD YYYY
If still employed, leave this blank
Current or Final Hourly Rate $ . Dollars Cents
Reason for Leaving
Circumstances of Separation Terminated Quit Lay-off No longer in business
Name of Next Most Recent Employer
Your Position

Please list your job title, or a description of the work you performed for this employer
Next Most Recent Employer's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Employer's Phone - (###) - ### ####
Name of Supervisor First Last
Please list the name of the person who was your immediate supervisor
May we contact your Supervisor? Yes No
Starting Date / MM / DD YYYY
Leaving Date / MM / DD YYYY
Final Hourly Rate $ . Dollars Cents
Reason for Leaving
Circumstances of Separation Terminated Quit Lay-off No longer in business
Name of Next Most Recent Employer
Your Position
Next Most Recent Employer's Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Employer's Phone - (###) - ### ####
Name of Supervisor First Last
May we contact your Supervisor? Yes No
Starting Date / MM / DD YYYY
Leaving Date / MM / DD YYYY
Final Hourly Rate $ . Dollars Cents
Reason for Leaving
Circumstances of Separation Terminated Quit Lay-off No longer in business
Personal References

Below, give the names and contact information of 3 persons you are not related to, whom you have known at least 1 year
Name First Last
How do you know them?
How many years have you been acquainted?
Phone - (###) - ### ####
Email
Name First Last
How do you know them?
How many years have you been acquainted?
Phone - (###) - ### ####
Email
Name First Last
How do you know them?
How many years have you been acquainted?
Phone - (###) - ### ####
Email
Have you ever been convicted of a felony? * Yes No
If "yes", please explain:

Please describe the circumstances of your felony conviction. A felony conviction does not necessarily exclude you from consideration.
Authorization * I certify that all facts contained in this application are true & complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above, and release Broad Ripple Veterinary Management Solutions, Inc from all liability for any damage that may result from utilization of such information.
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Employment Application

Employment Application

Former Employers

Personal References