(Full) LP Application

Personal Information

Name

First

Last

Email

Address

City

State/Province

Zip/Postal

Phone

States currently licensed in

States previously licensed in but not renewed

Would you be willing to relocate?

Where?

Please Explain

Preferred commute time

Have you been an owner/partner with another organization in the past?

Where

When?

For how long?

Why did you stop being an owner/partner?

Do you have a non-compete/non-solicit in place?

What is the address of your non-complete/non-solicit?

What is the mileage of your non-compete/non-solicit?

What are the time parameters of your non-compete/non-solicit?

Why would you make a great partner?

Why would you make a great CityVet partner?

What skills or experience do you have that might be considered unique from other applicants?

Tell us about your experience with leading a team and describe your leadership style

What qualities would you build your culture off of?

Schedule

How many hours a week do you work?

Please describe your schedule (days per week, surgery days, relief shifts, etc.)

When your clinic initially opens, do you have any schedule restrictions (days of the week, shifts, etc.)?

Production

How many pets, on average, do you see daily?

What is your average ACT (average client transaction)?

What is the approximate amount of hospital revenue you generate per day?

Is there anything you’d like to expand on?

Medical Practice Proficiency

How do you determine if you are able to work up a medical case or refer out?

Are there any components of general practice you are opposed to performing?

List any medicine/surgery competencies where you feel you lack experience, confidence, or need more support.

What non-routine surgical cases have you had the most experience with? What has been the success rate?

Financial Information

What is your approximate current balance of your student loan debt (write N/A if none)?

Do you currently have personal debt greater than $20,000 excluding student loans?

Please specify types and approximate balance(s) of personal debt greater than $20,000 (excluding student loans)?

How much capital do you have to invest in a CityVet location?

Have you ever filed for bankruptcy?

Skills and Proficiency

Please indicate your practical experience, proficiency and confidence in the following areas. 1 is least experience/proficient/confident and 5 is most experience/proficient/confident.

This area is available for any additional explanation you want to provide for the ratings above in the Skills and Proficiency section

References

Reference #1: Supervisor

Name

First

Last

Job/Occupation

Phone

Email

Reference #2: Peer

Name

First

Last

Job/Occupation

Phone

Email

Reference #3: Subordinate

Name

First

Last

Job/Occupation

Phone

Email