MCP Job Application Form

Job Application

The information given on this form is solely for the use of PBW Pharmacy INC and will be held in the strictestconfidence. It will be to the applicant’s advantage to answer each question fully and accurately. The use ofthis form does not indicate that there are any positions open and does not obligate the Company in any way.
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
LinkedIn
Position Applied
How did you hear about us
Are you at least 18 years of age?

YesNo
Have you previously worked for our company?

YesNo
Have you ever plead guilty or nolo contender (no contest), received deferred adjudication, received probation, court ordered communitysupervision, pre-trial diversion, or been convicted of any criminal offense (felonies and misdemeanors) other than minor traffic citations?

YesNo
If yes, please list the date, nature, locations and disposition
Present (or last) Employment
Please include: Company Name, address, supervisor name, timeframe that you were employed there.
Previous Employment
Please include: Company Name, address, supervisor name, timeframe that you were employed there.
Education
Please include high school name, dates attended, college name, dates attended, degree
References
Please list three references, their occupation, and contact information.
Available Start Date

MonthDayYear
Date
Upload Your Resume

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Cover Letter
APPLICANT’S STATEMENT (Applicant must review and sign below.)

I affirm that I have read and fully completed both sides of this application and all information as written above is true and correct, and I acknowledge that I may be terminated at any time if any information I supply is false. I acknowledge that this application will remain active for no more than 45 days. If I wish to be considered for employment after this 45 day period, I will reapply. I understand that if I am employed by PBW Pharmacy INC my employment and compensation can be terminated, with or without cause and with or without prior notice.

I authorize the references listed on this application to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I hereby grant PBW Pharmacy INC the right and privilege to withhold, retain or deduct an amount up to and including the total amount of indebtedness, advances, charges for personal purchase on Company accounts, or any other amounts owed to PBW Pharmacy INC, or any of its affiliates, subsidiaries, or divisions, from any salary, wages, commissions, or any other debt owed to me by the Company.

I understand that I am required to abide by all rules and regulations of the Company. I acknowledge that these policies and procedures, and any benefits or other terms and conditions of my employment, may be changed, interpreted, withdrawn or addedto by the Company at any time without prior notice to me.

PBW PHARMACY , INC. AND ITS AFFILIATES, IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE AGAINST APPLICANTS OR EMPLOYEES ON THE BASIS OF RACE, COLOR, SEX, AGE, RELIGION, NATIONAL ORIGIN, OR DISABILITY.
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