Pre-employment Questionaire
Date
04
/
19
/
2025
Name
Email
Home Phone
Cell Phone
Present Address
Permanent Address
What position are you applying for?
Customer Service Representative
Vet Assistant
Vet Technician
Certified Vet Technician
Surgical Vet Tech
ER Vet Tech
Oncology Vet Tech
Hospital Manager
Veterinarian
Customer Service Representative
If you are applying after learning about a job posting, please indicate where this job posting was found:
A CCVS employee referred me
Monster
Indeed
Zip Recruiter
Linkedin
Glassdoor
Facebook Job posting
I don't know about a job posting.
Other:
Name of CCVS employee that referred me:
Salary or Hourly Rate Desired?
What would you like your tentative start-date be, if offered a position?
MM
/
DD
/
YYYY
What is your current employment status?
Employed
Self-Employed
Unemployed
Student
May we inquire with your present employer?
Yes
No
Are you looking for Part-time or Full-time?
Prefer Part-time
Prefer Full-time
Flexible
EDUCATION/TRAINING:
EDUCATION HISTORY:
High School: Names/Location
Years attended, Subjects studied
High School: Did you graduate?
Yes
No
GED
In high school currently.
College:
Name and location, years attended,
Subjects studied-
College: Did you graduate?
Yes
No
In college currently.
Trade or Business School:
Name and location, years attended,
Subjects studied-
Trade/Business School: Did you graduate?
Yes
No
In college currently.
Please use this area to list any Military Duty/Type of Discharge, awards, or other special study, training, skills or research work not mentioned above.
REFERENCES:
PLEASE LIST AT LEAST TWO (2)
PROFESSIONAL
REFERENCES HERE:
1. Name
Relationship to you?
Email
Phone
2. Name
Relationship to you:
Email
Phone
3. Name
Relationship to you:
Email
Phone
EMPLOYERS:
CURRENT/FORMER EMPLOYERS:
#1 NAME & ADDRESS OF EMPLOYER (MOST RECENT FIRST)
PLEASE INCLUDE DATES OF EMPLOYMENT, SALARY, POSITION, AND REASON FOR LEAVING:
#2 FORMER EMPLOYER, if applicable:
NAME & ADDRESS OF EMPLOYER
PLEASE INCLUDE DATES OF EMPLOYMENT, SALARY, POSITION, AND REASON FOR LEAVING:
#3 FORMER EMPLOYER, if applicable:
NAME & ADDRESS OF EMPLOYER
PLEASE INCLUDE DATES OF EMPLOYMENT, SALARY, POSITION, AND REASON FOR LEAVING:
#4 FORMER EMPLOYER, if applicable:
NAME & ADDRESS OF EMPLOYER
PLEASE INCLUDE DATES OF EMPLOYMENT, SALARY, POSITION, AND REASON FOR LEAVING:
AVAILABILITY:
If we want to set up a phone interview after reviewing your resume/application, what days and time-ranges are best for you?
(Here are some examples you might provide)
- Any Friday afternoon between 1 and 5pm
- Any weekday morning from 8am - Noon
- Evenings only after 6pm
Any employee may be required to undergo random testing for alcohol or drug abuse at any time during employment. Please acknowledge your understanding here:
Yes, I understand that I may be subject to random drug testing during the course of my employment.
Would you like to upload a Resume and/or Cover letter?
Yes
No
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