Job Application

Full Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Do you receive text messages at this number?

E-mail

Are you 18 years of age or older?

Are you a U.S. citizen?

Position Applying For

Date You Can Start

MonthDayYear

Salary Desired ($ per hr)

Have You Worked Here Before?

Have You Applied Here Before?

Days available to work

High School

Name of High School Attended

Number of Years Attended

Graduated?

College

Name of College/University Attended

Number of Years Attended

Graduated?

Area of Study/Degree

Graduate School

Name of Graduate School Attended

Number of Years Attended

Graduated?

Area of Study/Degree

Trade School/Other

Name of Trade/Technical/Other School Attended

Number of Years Attended

Graduated?

Area of Study/Degree

Skills

List any relevant skills

Qualifications

List any relevant certifications or qualifications

Current Employer

Name of Current Employer or NONE if not Employed

Position

Salary

Reason for Leaving?

Start Date

MonthDayYear

May We Contact?

Previous Employer

Name of Previous Employer

Position

Salary

Reason for Leaving?

Start Date

MonthDayYear

End Date

MonthDayYear

Previous Employer

Name of Previous Employer

Position

Salary

Reason for Leaving?

Start Date

MonthDayYear

End Date

MonthDayYear

Reference 1

Name of Reference

Relationship

Years Acquainted

Phone

Email

Reference 2

Name of Reference

Relationship

Years Acquainted

Phone

Email

Reference 3

Name of Reference

Relationship

Years Acquainted

Phone

Email

Cover Letter

Upload a File

Resume

Upload a File

By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

Also, by clicking submit below, I give consent for Scottsboro Family Pharmacy to conduct a criminal background check on the applicant. I also understand that applicants may be tested for use of illegal drugs.

Employment Application Form

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Send Application: