Tech Extern Information

Name*

First Last

Date of birth*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Alternate Phone (optional)

Email*

Where did you hear about VSC?*

Are you Rabies Vaccinated?*

Yes
No
In the Process

Education

List all education experiences*

Institution Type (e.g. high school)	Institution Name	Dates Attended (e.g. 8/1998 - 6/2002)	Name of degree (write NA if not applicable)

What school are you currently attending?*

What Term/Semester are you in currently?*

When is your expected graduation date?*

Resume Upload*

Uploading a resume is a requirement in order to be considered for our program.

Drop files here or

Max. file size: 50 MB.

Exact dates of externship (e.g. 5/20/20 - 6/20/20)*

Are you interested in employment with VSC after your externship?*

Yes, Full Time
Yes, Part Time
No

Your Shadow Day is only offered on a weekday and must begin at 9:30am. Please list several DATES that you would be available to come in for your Shadow Day.*

IMPORTANT: Shadow Day must be completed prior to start of externship.

What initially interested you in the veterinary industry?*

List any information you would like us to know when considering you for an externship:*

Please list what specialties you are most interested in:*

Please list what specialties you are most nervous about visiting:*

Employment History

(List current or most recent employer first)

Company #1

Name of employer	Phone	Address	City/State	Position	Duration of employment	Supervisor's name/title

Do you currently work for Company #1?

Yes
No

May we contact Company #1?*

Yes
No

Company #2

Name of employer	Phone	Address	City/State	Position	Duration of employment	Supervisor's name/title

Do you currently work for Company #2?

Yes
No

May we contact Company #2?*

Yes
No

Company #3

Name of employer	Phone	Address	City/State	Position	Duration of employment	Supervisor's name/title

Do you currently work for Company #3?

Yes
No

May we contact Company #3?*

Yes
No

Company #4

Name of employer	Phone	Address	City/State	Position	Duration of employment	Supervisor's name/title

Do you currently work for Company #4?

Yes
No

May we contact Company #4?*

Yes
No

Signature*

I hereby certify that the information contained in this application is true and correct to the best of my knowledge and agree to have any of the statements checked by Veterinary Specialty Center. I authorize the references listed above, as well as all other individuals whom Veterinary Specialty Center contacts, to provide any and all information concerning my previous employment and any other pertinent information that they may have.

Further, I release all parties and persons from any and all liability for any damages that may result from furnishing information to Veterinary Specialty Center, as well as from the use or disclosure of such information by Veterinary Specialty Center agents, co-workers or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my dismissal from employment.

Veterinary Specialty Center is an equal opportunity employer. Veterinary Specialty Center does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 90 days. At the conclusion of this time, if I have not heard from the employer and still want to be considered for employment, it will be necessary to fill out a new application.

Email

This field is for validation purposes and should be left unchanged.

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