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Saint Francis of Assisi Veterinary Medical Center 8615 Potranco Road San Antonio, Texas 78251 (210) 509-8500 _______________________________________________________________ Application For Employment

Name: Last________________First_____________Middle___________DOB__________ Present Address___________________________City/State_____________Zip________ Phone: Home(____)____________Alt.(____)________________SSN________________

Employment Desired

Position _________________________Date you can start?______________salary desired________ Are you presently employed?_____ May we contact your last employer?_____is so, List contact person, __________________  phone number(____)______________, and title_______________________.

Availability

Sunday          Monday          Tuesday          Wednesday          Thursday          Friday          Saturday ______         ______           ______           _________           _______         ______         _______ ______         ______           ______           _________           _______         ______         _______

Education:     Name & Location of School      Years attended       Major      Graduate High School         __________________________         ______________         ______        ________                              __________________________          College                __________________________         ______________         ______         ________                             __________________________          Other                   __________________________           _____________          ______          ________                             __________________________

Are you currently enrolled in school?_____________ If so, how many hours are you enrolled in?________

Skills:     Microsoft_____    Excell_____  10 key_____  Avimark_____ WPM_____ Other:____________________________________________________________________________

Former Employers: (Starting with most recent)

Dates       Company Name             Position          Supervisor's Name              Salary                 Reason for leaving  (Mo/Yr)        and Address                                      and Phone number       (starting/ending) _______     _________________    __________   ___________________   _____________   _______________ _______     _________________                           ___________________   _____________   _______________ _______     _________________    __________   ___________________   _____________   _______________ _______     _________________                           ___________________   _____________   _______________ _______     _________________    __________   ___________________   _____________   _______________ _______     _________________                           ___________________   _____________   _______________

References(list references other than family members)

Name                 Address             Business          Phone Number             Relation          Years Known __________  _______________  __________   (____) _________   _______________  _________ __________  _______________  __________   (____) _________   _______________  _________ __________  _______________  __________   (____) _________   _______________  _________ __________  _______________  __________   (____) _________   _______________  _________

Thank you for your interest in employment at St. Francis of Assisi Veterinary Medical Center.  You will be contacted only if an appropriate position becomes available and/or if an interview needs to be arranged.        Signature______________________________             Date________________