Employment Application Form

Current Job Opening(s):

Pharmacy Clerk

Full Time

Job duties include but are not limited to assisting with prescription intake and pick-up, answering phones, entering and maintaining patient profiles, prescription order entry, communicating with medical offices and insurance companies, ordering over-the-counter medications, stocking shelves, filing, and cleaning work areas. The job requires computer and math skills, as well as excellent communication skills. Physical requirements include standing for long periods of time and occasional light lifting (up to 30lbs).

At North Lake Medical Pharmacy, we get to know our patients. We put their needs first and strive to provide the best possible healthcare and service experience possible for each person who walks through the door. We are seeking someone who is friendly, detail-oriented, willing to learn, reliable, and excited to work as part of a team.

High school diploma or GED required. Pharmacy, healthcare or retail experience preferred. Must be willing to undergo background check and drug test. Vaccinations required.

Please fill out the application below to indicate your interest and suitability for a position at North Lake Medical Pharmacy. If we do not currently have a job opening for the position you are looking for, feel free to fill out the application anyway and we will keep your information on file. Thank you!

Name:*

First NameLast Name

Birth Date*

MonthDayYear

Phone Number:*

Area CodePhone Number

E-mail Address:

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How were you referred to us?*

Other:

Referred By:

Position Desired:*

Other:

Date you can start:*

Date

Wage desired:*

Are you employed now?*

YesNo

If so, may we contact your present employer?

YesNo

Have you ever applied to work at North Lake Medical Pharmacy before?*

YesNo

Are you currently serving in the United States military or are you a veteran?*

YesNo

If yes, U.S. Military or Naval Service and Rank:

Education History

High School (Name & Location)*

Years Attended*

Did you graduate?*

YesNo

If no, did you get your GED?

YesNo

College (Name & Location)

Years Attended

Did you graduate?

YesNo

Major / Subject(s) Studied:

Trade/Graduate/Business/ Correspondence School/Other (Name & Location)

Years Attended

Did you graduate?

YesNo

Major / Subject(s) Studied:

Job Skills & Training

Describe your skills:*

What is your level of competency with computers?*

BasicIntermediateAdvancedTech Wizard

What customer service experience do you have?*

Training or Certifications:

Former Employers List your last four employers, starting with the most recent.

Employer 1

Dates of Employment

From

To

Name of Employer

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Position Title

Salary

Reason for Leaving

Employer 2

Dates of Employment

From

To

Name of Employer

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Position Title

Salary

Reason for Leaving

Employer 3

Dates of Employment

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Name of Employer

Address

Street Address

Street Address Line 2

CityState / Province

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Area CodePhone Number

Position Title

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Employer 4

Dates of Employment

From

To

Name of Employer

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Position Title

Salary

Reason for Leaving

References Please list two (2) references not related to you that are familiar with your work life.

Reference 1

Name:*

First NameLast Name

Phone Number*

Area CodePhone Number

Years Known:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Reference 2

Name:*

First NameLast Name

Phone Number*

Area CodePhone Number

Years Known:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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