Legends Pharmacy Employment Application

Legends Pharmacy Application for Employment
Legends Pharmacy is an equal opportunity employer. Legends Pharmacy does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.
Personal Information
Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
YesNo
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?
Position Information
Date You Can Start

MonthDayYear
Date
Salary Expectations($)
Position Desired
Employment Desired(e.g., Full-Time)
Are you currently employed? If yes, may we inquire of your present employer?
Referral Source
Company WebsiteJob Board (e.g., Indeed, LinkedIn)Employee ReferralSocial MediaOther
Employee Referral Name (if applicable)
Other (please specify)
YesNo
YesNo
If yes, who?
Education & Training
High School
Name of High School Attended
Number of Years Attended
YesNo
College/University
Name of College/University Attended
Number of Years Attended
Degree
YesNo
Graduate School
Name of Graduate School Attended
Number of Years Attended
Degree
YesNo
Other Training/Certifications
Name of Trade/Technical/Other School Attended
Program/Certification
Institution/Provider
YesNo
Professional Licenses and/or Certifications
License and/or Certification (e.g. list type, organization or state issued)
Employment History

Include your last seven (7) years of employment history, starting with the most recent.
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Employer Name
Name of current employer or N/A if not employed
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Immediate supervisor name and title
Summarize the nature of work performed and essential responsibilities
Reason for Leaving?
Salary ($)
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Employer Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Immediate supervisor name and title
Summarize the nature of work performed and essential responsibilities
Reason for Leaving?
Salary ($)
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Employer Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Immediate supervisor name and title
Summarize the nature of work performed and essential responsibilities
Reason for Leaving?
Salary ($)
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Employer Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Immediate supervisor name and title
Summarize the nature of work performed and essential responsibilities
Reason for Leaving?
Salary ($)
References

Please list at least two professional references (supervisors, managers, colleagues, or academic advisors). Do not include relatives or personal friends.
Reference 1
Name of Reference
Relationship/Title
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference 2
Name of Reference
Relationship/Title
Company
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Resume Upload
Resume

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Applicant Acknowledgement and Certification
By clicking the Submit button below, I certify that all the information I have provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may disqualify me from further consideration for employment, and if employed, may result in my dismissal at any time.

I authorize the investigation of all statements contained in this application and release all parties from liability for furnishing such information.

I understand that this application is not a contract of employment. If hired, my employment will be “at-will,” which means that either I or the company may terminate employment at any time, with or without cause or notice, subject to applicable law.
Signature

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Date

MonthDayYear
Date
Should be Empty:

Legends Pharmacy Application for Employment

Personal Information

Position Information

Referral Source

Education & Training

Professional Licenses and/or Certifications

Employment History

References

Resume Upload

Applicant Acknowledgement and Certification