Our Family Pharmacy Employment Application

Employment Application Form

Our Family Pharmacy is an Equal Opportunity Employer and all applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age.
About You:
Application Date

MonthDayYear
Date
Position Applying For
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
When will you be available to start work?

MonthDayYear
Check which job status you would accept

Full-timePart-time
Are you at least 18 years of age?

YesNo
Are you legally eligible for employment in the United States?

YesNo
Can you, after offer of employment, submit verification of your legal right to work in the United States?

YesNo
Have you ever applied to work for Our Family Pharmacy?

YesNo
If yes, list positions applied for:
Have you ever been employed by Our Family Pharmacy?

YesNo
If yes, list dates of employment:
Were you recommended by a current or former employee?

YesNo
If yes, to whom do we owe a “Thanks”:
Do you have scheduling preferences (like morning, night or weekend shifts)

YesNo
If yes, please list preferences:
Please list all languages that you can speak/read/write/understand:
Education:

Please list all relevant education
High School
Name of High School Attended
Number of Years Attended
Graduated?

Yes
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
Licensure:

Please list all licenses, certificates, or authorizations to practice a trade or profession
Type
List any relevant skills
License Number
List any relevant certifications or qualifications
Granted By / Year Issued
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
From - To (mo/yr)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hours Per Week
Duties
Accomplishments
Equipment Used
Supervisor
May We Contact this employer/supervisor?

YesNo
Contact Phone

Area CodePhone Number
Reason for Leaving?
Previous Employment:
Previous Employer
Name of Previous Employer
Position
From - To (mo/yr)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hours Per Week
Duties
Accomplishments
Equipment Used
Supervisor
May we contact this employer/supervisor?

YesNo
Contact Phone

Area CodePhone Number
Reason for Leaving?
Previous Employer
Name of Previous Employer
Position
From - To (mo/yr)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hours Per Week
Duties
Accomplishments
Equipment Used
Supervisor
May we contact this employer/supervisor?

YesNo
Contact Phone
Reason for Leaving?
References:

Please list three professional references we can contact who can speak to your work qualifications
Name
Name of Reference
Phone Number

Area CodePhone Number
Relationship
Name
Name of Reference
Phone Number

Area CodePhone Number
Relationship
Name
Name of Reference
Phone Number

Area CodePhone Number
Relationship
Cover Letter & Resume:
Cover Letter (optional)

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Send Application:
I hereby certify the answers provided on this application are true and correct the best of my knowledge. I hereby authorize Our Family Pharmacy to investigate my references, current/former employers, education, licensing, and all other matters related to my suitability for employment. I understand that nothing contained in this application or any related interviews is intended to create an employment contract between me and Our Family Pharmacy. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period of time and may be terminated at any time, with or without cause or prior notice, by myself or the company.
Applicant’s Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Employment Application Form

About You:

Education:

Licensure:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume:

Send Application: