APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
Akers Pharmacy, Inc. is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law.
INTRODUCTORY INFORMATION:
Date:*

MonthDayYear
Date
Full Name:*
First, Middle, Last
Email Address:*
example@example.com
Address:*
City:*
State:*
Zip:*
Cell Phone:*
Type of work desired:*
Salary desired:*
If hired, can you provide documents required to establish your eligibility to work in the U.S.?*

YesNo
Are you 16 years of age or older?*

YesNo
How were you referred to Akers Pharmacy?
Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation?*

YesNo
If yes, please explain in detail below and include the date of final disposition of the case and the nature of the offense. This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
Explain here
EDUCATION:
Name and Location (City and State) of High School:*
Graduation Year*
Name of College or Technical School
Course of Study:
Number of years completed:
Degree/Diploma:
MILITARY EXPERIENCE:
Branch of Service:
From:
To:
Rank/Type of Service:
Special Training/Experience:
RECORD OF EMPLOYMENT:
List positions starting with most recent:
Employer:
Address
Telephone:
Position Title
Start Date:

MonthDayYear
Date
Date Left:

MonthDayYear
Date
Ending Salary:
Duties
Reason for Leaving
Employer
Address:
Telephone Number
Position Title
Start Date

MonthDayYear
Date
Date Left

MonthDayYear
Date
Ending Salary
Duties:
Reason for Leaving:
Work-Related References (Do not include relatives):*

Name

Occupation

Years KnownTelephone Number

Company
Work-Related References (Do not include relatives):

Name

Occupation

Years KnownTelephone Number

Company
Work-Related References (Do not include relatives):

Name

Occupation

Years KnownTelephone Number

Company
STATEMENT (Please read this statement carefully before signing this application):

I understand that employment with Akers Pharmacy, Inc. (the Company) is at-will, meaning that I or the Company may terminate my employment at any time, or for any reason consistent with applicable state or federal law.

I authorize the Company to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the Company, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information.

I understand that the Company requires the successful completion of a drug and/or alcohol test as a condition of employment.

I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.
Signature of Applicant:*

Clear
Date*

MonthDayYear
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT

INTRODUCTORY INFORMATION:

EDUCATION:

MILITARY EXPERIENCE:

RECORD OF EMPLOYMENT: