Employment Application

Pittsburgh Veterinary Specialty and Emergency Center does not discriminate on the basis of race, religion, national origin, color, sex, age, veteran status, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

Please provide as much information as possible. Fields followed by an asterisk (*) are required.

General Information

Name *

Address *

City *

State *

Zip *

Email Address *

Phone Number *

Employment Desired
Position Desired *	Please check *
Desired Pay Rate *	Date Available *
Currently Employed *	Have you been employed by this company before *
Are you related to or know anyone employed here *	If so, who
Licensed/Certified Technician *	Date licensure obtained

Background
Have you been charged with a misdemeanor/felony? *	If yes, please explain

Education
High School *	Graduation date *
College/Trade school	Years attended
Graduation date	Degree

Other school	Years attended
Graduation date	Degree
Please list other accomplishments, certificates, and/or achievements
Dates of military service and branch

Employment History
Employer	Dates
Position	Wage
Reason for Leaving	Responsibilities
Supervisor	Phone Number

Employer	Dates
Position	Wage
Reason for Leaving	Responsibilities
Supervisor	Phone Number

Employer	Dates
Position	Wage
Reason for Leaving	Responsibilities
Supervisor	Phone Number

Employer	Dates
Position	Wage
Reason for Leaving	Responsibilities
Supervisor	Phone Number

Professional References
Name *	Professional Relationship *
Phone Number *	Years Known *

Name *	Professional Relationship *
Phone Number *	Years Known *

Name *	Professional Relationship *
Phone Number *	Years Known *

Hobbies

Upload Resume and Cover Letter
If you choose to, please upload your cover letter and resume as a combined document

Affidavit
I certify that the facts contained in this application are true and complete to the best of my knowledge. Any false statements on this application will permit dismissal from consideration. I authorize Pittsburgh Veterinary Specialty and Emergency Center to contact any schools, employers, or persons named in my resume for further investigation and release both parties from all liability for damage that may result from utilization of such information. Any false statement or omission on this application will disqualify me from employment.

Date *	Electronic Signature *

Employment Application

General Information

Employment Desired

Background

Education

Employment History

Professional References

Upload Resume and Cover Letter

Affidavit