U-Save-It Pharmacy Employment Application

High School
Address

Street Address

CityState

Zip Code
# of Years Completed:
Did you graduate?
GPA
Class Rank
College/University:
Address

Street Address

CityState

Zip Code
# of years completed
Did you Graduate?
Degree/Major:
GPA:
Class Rank
Other Education:

1st Reference & Phone:
2nd Reference & Phone:
3rd Reference & Phone:
Summarize your special skills or qualifications:

Previous Employment (begin with most recent position):
Start Date of Employment

MonthDayYear
End Date of Employment

MonthDayYear
Position(s) Held:
Firm:
Address:

Street Address

CityState

Zip Code
Phone Number:
Supervisor/Title:
Responsibilities:
Staring salary and title:
Ending salary and title:
Reason for Leaving:
May we contact this employer for reference?
2nd Previous Employment (skip if not applicable)
Start Date of Employment

MonthDayYear
End Date of Employment

MonthDayYear
Position(s) Held:
Firm:
Address:

Street Address

CityState

Zip Code
Phone Number:
Supervisor/Title:
Responsibilities:
Staring salary and title:
Ending salary and title:
Reason for Leaving:
May we contact this employer for reference?

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I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers schools or persons from all liability in responding to inquiries in connection with my application.

In the even I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature
Date

MonthDayYear
Date
Please verify that you are human
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