Join Our Team
Employment Application
Please complete all sections
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Previous Work Experience (please list three most recent places of employment, if applicable, from most recent to least recent)
*
Date You Are Available to Begin Employment
*
-
Month
-
Day
Year
Date
Days You Are Available to Work
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Are you at least 18 years of age? (Required for some positions)
*
Yes
No
Desired Position (select all that apply)
*
Cashier
Pharmacy Technician (must be at least 18 years of age and have a high school diploma or equivalent)
Pharmacist (must be at least 18 years of age and have a BSPharm or PharmD degree)
Type of Employment Desired (select all that apply)
*
Full-time
Part-time
Seasonal
Languages You Are Fluent In
*
English
Spanish
American Sign Language
Other
Rate How Punctual You Think You Are
*
Always Punctual
Often Punctual
Sometimes Punctual
Rarely Punctual
Rate Your Handwriting Skills
*
Excellent
Good
Average
Poor
Rate Your Verbal Communication Skills
*
Excellent
Good
Average
Poor
Rate Your Time Management Skills
*
Excellent
Good
Average
Poor
Rate Your Willingness to Learn New Information or Skills
*
Excellent
Good
Average
Poor
Rate How Often You Exhibit a Positive Attitude
*
Always
Often
Sometimes
Rarely
Do you have reliable transportation?
*
Yes
No
If you are hired as a pharmacy technician, you are expected to pass a certification exam within one year of your hire date. The pharmacy pays for the exam cost for your first attempt. Do you agree to this condition?
*
Yes
No
If offered a position, you will be expected to pass a background check prior to employment and monthly throughout employment. Do you consent to having your information submitted for background checks?
*
Yes
No
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: