Clinic

Application for Employment (Farms & Maintenance)

EMP SERV, LLC

PO Box 370
Pipestone, MN 56164
Phone: 507-825-2532 Fax: 507-825-2205 Email: hr@pipestonesystem.com

It is this company’s policy to provide equal opportunities in its operation and in all areas of its employment practices and to assure that there will be no discrimination against any employee or applicant for employment as provided by law. Applicants requiring accommodation in the application and/or interview process should notify a representative of the Human Resources department.

Please click the submit button only once when submitting your application.

First Name: MI: Last Name:
Address: City: State: Zip:
Home Phone: Cell Phone:    Email:

Have you previously been employed with Pipestone before?:
 Yes No
If yes, when? From: mo/year to mo/year
If no, how did you hear about Pipestone?
Referred by:
Pipestone Employee - Name :
You heard about us through a:
 Career Fair Classified Ad.
Other:

Position Applying For :
Region :
 Full Time Part Time Seasonal/Internship (check all that apply)
Available to Work:
 Days Evenings Weekends (check all that apply)
Are you willing to relocate?  Yes No
Do you have reliable transportation?  Yes No

Are you at least 16 years of age?    Yes No

Are you at least 18 years of age?    Yes No

Do you or anyone who lives in your residence have contact with swine?  Yes No

Do you or anyone you live with work with meat processing?  Yes No

EDUCATION

Name of School
City, State
Grade Completed
Graduate?
Major
 Graduate
 Graduate
 Graduate

Please state any special achievements, qualifications or experience that you may have in addition to the education listed above, which would qualify you for the position you are applying.


PREVIOUS WORK EXPERIENCE – Please give five years of work history, starting with your most recent employer.

Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:
Company Name: City: State: Telephone:
Supervisor Name: OK to Contact:  Yes No Employment Dates: To:
Job Title: Starting Pay Rate: Ending:
Reason For Leaving:

VETERINARY PRACTICE JOB EXPERIENCE

Please list any veterinary facilities you have been employed with, number of years, and areas of responsibility.

Veterinary Facility:  

City, State :  

(Area Code) Telephone :  

Number Of Years:

Areas of Responsibility – Select ALL that apply
 Inventory Control
 Facilities Maintenance
 Scheduling
 Budget/Financial Statements
 Select/Hire Staff
 General bookkeeping
 Client Education
 Marketing
 Reception/Supervise Receptionists
 Technician/Supervise Technicians
 Equipment and Bulk Purchasing
 Test Charts
 Financial Management
 Hiring/Training Staff
 Internal Controls
 Health Certificates
 Continuing Education
 Accounts Receivable/Collection
 Accounts Payable
Large Animal Technician Experience – Select ALL that apply
 Bovine (Beef)
 Equine (Horse)
 Porcine (Swine)
 Ovine (Sheep)
Computer Program Experience – Select ALL that apply
 Microsoft Word
 PowerPoint
 Excel
 Access

Number of Doctors:  

Number of Staff:  

Your Title:  

Type of Practice - select one
 Small Animal
 Specialty/Referral
 Large Animal
 Mixed

Veterinary Facility #2:  

City, State :  

(Area Code) Telephone :  

Number Of Years:

Areas of Responsibility – Select ALL that apply
 Inventory Control
 Facilities Maintenance
 Scheduling
 Budget/Financial Statements
 Select/Hire Staff
 General bookkeeping
 Client Education
 Marketing
 Reception/Supervise Receptionists
 Technician/Supervise Technicians
 Equipment and Bulk Purchasing
 Test Charts
 Financial Management
 Hiring/Training Staff
 Internal Controls
 Health Certificates
 Continuing Education
 Accounts Receivable/Collection
 Accounts Receivable/Collection

Number of Doctors:  

Number of Staff:  

Your Title:  

Type of Practice - select one
 Small Animal
 Specialty/Referral
 Large Animal
 Mixed

REFERENCE CHECK – Please list three people who are not related to you and who are not previous employers.

Name
Email Address
(Area Code) Telephone
Occupation
Years Known

RESUME UPLOAD (optional) – If you have a resume you would like to attach you can do so here, this is not required however.

I certify that the answers I have provided to the questions and statements are true and correct to the best of my knowledge. I understand that any omissions, misleading statements or incorrect answers made by me may render this application void and, if employed, would be cause for termination.

All applicants should be advised that the Social Security Administration verifies the validity and authenticity of information given to Pipestone, LLC’s Human Resources and/or Payroll Departments for proof of employment eligibility. Any employee found to have presented fraudulent or falsified documents will be subject to immediate disciplinary action, up to and including termination of employment. Pipestone will provide no reimbursement, support or sponsorship for any employee found to have presented false information regarding employment eligibility.

Pipestone is an Equal Opportunity Employer.

Pre-employment drug test and background screening required.

Please click the submit button only once when submitting your application.