Fredonia Pharmacy Application

Job Application

Please complete all info.
APPLICANT INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Available Start date*
Position Applying for:*
Desired Salary*
Desired start date:*

MonthDayYear
Date
Are you a citizen of the United States?*

YesNo
Are you authorized to work in the United States?*
EDUCATION
High School Attended:*
Years attended:*
example: 2016 - 2020
College Attended:
Years attended:
example: 2016 - 2020
Did you graduate?

YesNo
What is your degree in?
List all degrees
Please list any trade schools or other trainings that you have:
list all trainings
REFERENCES:
Please list 3 professional references.*
PREVIOUS EMPLOYMENT - Please list 10 years of work history
Company #1*
Company Phone #1*
Please enter a valid phone number.
Supervisors Name #1*
Job Title #1*
Ending Salary #1*
Job Duties #1:*
Dates employed #1:*
start date and end date
Reason for Leaving #1:*
May we contact your supervisor #1?*

YesNo
Do you have a #2 employer to list?

YesNo
Company #2
Company Phone #2
Please enter a valid phone number.
Supervisors Name #2
Job Title #2
Ending Salary #2
Job Duties #2:
Dates employed #2
start date and end date
Reason for Leaving #2:
May we contact your supervisor #2?

YesNo
Do you have a #3 employer to list?

YesNo
Company #3
Company Phone #3
Please enter a valid phone number.
Supervisors Name #3
Job Title #3
Ending Salary #3
Job Duties #3:
Dates employed #3
start date and end date
Reason for Leaving #3:
May we contact your supervisor #3?

YesNo
I certify that my answers are true and complete to the best of my knowledge. If the application leads to employment, I understand that false or misleading information in my application or interview my lead to my release.

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Job Application