Colliers Employment Application
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you 18 or older?
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment Desired
Pharmacy Tech
Delivery
Cashier
Intern
Other
Hours per week desired
Add a number of hours. 32+ hours/week is full time. Fewer than 32 hours/week is considered part time.
Salary desired
Add the desired annual salary.
Date you can start
-
Month
-
Day
Year
Date
Are you employed now?*
Yes
No
Other
What days can you work
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Back
Next
Former Employers
Next, please list the last four employers, starting with the most recent job first. Add additional jobs past the fourth, as needed.
Employer business/company name
Employer City
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Position
Annual Salary
Start Date
-
Month
-
Day
Year
Date
Final Date
-
Month
-
Day
Year
Date
Reason for leaving
If still at this position, just indicate that.
Employer business/company name
Employer City
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Position
Annual Salary
Start Date
-
Month
-
Day
Year
Date
Final Date
-
Month
-
Day
Year
Date
Reason for leaving
If still at this position, just indicate that.
Employer business/company name
Employer City
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Position
Annual Salary
Start Date
-
Month
-
Day
Year
Date
Final Date
-
Month
-
Day
Year
Date
Reason for leaving
If still at this position, just indicate that.
Employer business/company name
Employer City
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Position
Annual Salary
Start Date
-
Month
-
Day
Year
Date
Final Date
-
Month
-
Day
Year
Date
Reason for leaving
If still at this position, just indicate that.
Any additional employment you would like to list
Back
Next
Submit
Employer References
Please list three work references we may contact about you.
Employer Reference #1
Reference #1 name
First Name
Last Name
Reference #1 business name
Reference #1 address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #1 phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #1 years acquainted
How many years have you known or worked for this person?
Employer Reference #2
Reference #2 name
First Name
Last Name
Reference #2 business name
Reference #2 address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #2 phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #2 years acquainted
How many years have you known or worked for this person?
Employer Reference #3
Reference #3 name
First Name
Last Name
Reference #3 business name
Reference #3 address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #3 phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference #3 years acquainted
How many years have you known or worked for this person?
Back
Next
In case of an emergency
Emergency contact name
First Name
Last Name
Emergency contact address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact phone
Please enter a valid phone number.
Format: (000) 000-0000.
Consent
Consent
*
I agree to the following
Submit
Should be Empty: