Keeseville Job Application Form

Employment Application Form:
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long have you lived here blanks.
Phone Number*

Area CodePhone Number
E-mail*
Employment Desired:
Position Applying For*
Date You Can Start*

MonthDayYear
How many years of pharmacy tech experience do you have? *
Salary Desired
Do you have a valid drivers license?*

YesNo
Have You Applied Here Before?

YesNo
Education:
High School
Name of High School Attended
Number of Years Attended*
Graduated?*

YesNoGEDOther
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications:
Skills*
List any relevant skills
Qualifications*
List any relevant certifications or qualifications
Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Salary
Reason for Leaving?*
Start Date

MonthDayYear
May We Contact?

YesNo
Previous Employment:
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
References:
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 & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Criminal History
1.Have you ever pleaded no contest, nolo contendere, or guilty to a misdemeanor crime or been convicted of a misdemeanor crime?

YesNo
2.Have you ever pleaded no contest, nolo contendere, or guilty to a felony crime or been convicted of a felony crime?

yesno
Note: Answering “yes” to either question one or question two above does not consitute an automatic bar to employment. The company will consider the nature of the crime, its seriousness, the substantial relation to the positions functions and qualification, the number of occurrences, the applicant's age at the time of the crime and time elapse since the crime, the applicants entire work and educational history, employment references and recommendations and the business necessity of any exclusion when required by state local or federal law.
If you answered yes to either of the questions above please dates and details for each incident.
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.
Should be Empty:

Employment Application Form:

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Criminal History