Equal opportunity is given to all applicants regardless of race, color, age, sex, religion, national origin, disability, pregnancy, genetic information, and military or veteran status.

This application shall become void after 30 days but can be reactivated for an additional 30 days by written request of the applicant.

1. If offered a position, the Immigration Reform and Control Act of 1968 requires you to furnish proof of your employment authorization and your identity before you begin work.
2. If offered a position, a background check, including a criminal record check, will be conducted.

Shift & Travel Availability

I authorize Haire Drug Center, or its agents, to obtain any information about my work history or personal information, including my character and qualification, credit rating, driving record, criminal record, education and previous employment. I authorize all persons, schools, companies, information service bureaus, governmental agencies and law enforcement authorized to release any information concerning my background to Haire Drug Center, whether or not it is in their records. I also authorize Haire Drug Center to obtain this information from any company that is in the business of providing applicant background checks. I hereby release the individuals or entities providing this information from all liability of any damage caused by issuing this information.

Please provide at least three (3) work references: References could be contacted by personnel of Haire Drug Center (supervisors or administration). These references should be able to provide accounts of your character and/or qualifications to perform the job for which you are applying. Please be assured that all information obtained from these references will be held in strict confidence.

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DISCLOSURE AND AUTHORIZATION TO RELEASE CONSUMER INFORMATION

In connection with your employment or application for employment with Healthcare Facility, a consumer report may be obtained. A consumer report includes any written, oral, or other communication of any information by a consumer reporting agency bearing on a consumer's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. By signing this form below, you hereby authorize Healthcare Facility and any of its agents, to obtain a consumer report on you.

I HEREBY AUTHORIZE HEALTHCARE FACILITY, AND ANY OF ITS AGENTS, TO OBTAIN A CONSUMER REPORT ON ME.

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DISCLOSURE AND AUTHORIZATION TO RELEASE CONSUMER INFORMATION

I certify that the answers given by me to the foregoing questions and statements are true and complete to the best of my knowledge, and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I acknowledge that misrepresentation or omission of facts called for in this application is cause for my not being hired or my termination at any time without prior notice to me.

I authorize Healthcare Facility to release to other prospective employers of information service bureaus, any information regarding my employment with healthcare Facility or the information set forth in this application or gained by Healthcare Facility from any other companies, agencies, schools or persons named in this application, including information regarding my employment, character, qualification and other information they may have regarding me, whether or not it is in their records. I hereby release Healthcare Facility from all liability for any damage caused by issuing this information to outside individuals.

If employed, I agree as a condition of continued employment to acquaint myself with, and to abide by all Rules, Regulations and Policies as established or amended by Healthcare Facility. However, I understand that any employment is at-will which means that my employment and compensation can be terminated with or without notice at any time, and for any reason other than an illegal reason, at the option of Healthcare Facility or myself. Nothing in this Application of Employment or the regulations and policies of the Healthcare Facility should be construed to constitute a contract of employment between Healthcare Facility and the applicant. I understand that no Healthcare Facility representative, other than the Administrator, in writing, has any authority to enter into an agreement for employment for any specified period of time, or to make any agreement contrary to this policy. I understand that my terms and conditions of employment may be changed at any time with or without notice to me. 

If I am employed, I further understand and agree that when my employment is terminated for any reason, I must return all of the healthcare Facility's property in my custody, including, but not limited to, any documents, Healthcare Facility equipment, office keys, manuals, identification cards and name badges before I am entitled to final payment of any amounts due me on separation. I also understand that the value of these items, if not returned, along with any monies I might owe Health Facility, may be deducted from my final paycheck; to the extent as allowed by law.

AUTHORIZATION TO RELEASE EMPLOYMENT AND EDUCATION RECORDS

I, ______________________ hereby authorize Healthcare Facility, or its agents, to obtain all records and/or information relating to my education and employment history. I hereby authorize all persons, entities or agencies possessing records and/or information relating in any way to my education and employment history to release all such information to Healthcare Facility's Human Resources Department.

I hereby release Healthcare Facility, and its agents, from any and all liability related in any way to its request or receipt of the information authorized herein, and I do also hereby release any and all persons, entities or agencies possessing records and/or information relating in any way to my education and employment history for any and all liability related in any way to the release of information in accordance with this Authorization.