Access Pharmacy | Access Specialized Care | Access Durable Medical Equipment | Cates Pharmacy | Hassler’s Drugs | Jasper Drugs | Standefer Pharmacy | Whitwell Pharmacy
Access Pharmacy, Access Specialized Care, Access Durable Medical Equipment, Cates Pharmacy, Hassler’s Drugs, Jasper Drugs, Standefer Pharmacy, and Whitwell Pharmacy are equal opportunity employers and do not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, or age. In addition, the company does not discriminate against qualified individuals with disabilities.
First name
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Last name
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Phone
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Email
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Country/Region
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Address
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City
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Zip / Postal code
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Position Applied For:
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Full Time or Part Time ?
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Full-Time
Part-Time
If part-time, how many hours are you available per week?
Are you willing to work any shift? Including nights and weekends?
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Yes
No
Location Applying for:
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Access Pharmacy
Access Specialized Care
Access Durable Medical Equipment
Cate's Pharmacy
Hassler's Drugs
Jasper Drugs
Standefer Pharmacy
Whitwell Pharmacy
Desired Pay:
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Have you applied with our company previously?
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Yes
No
If yes, when?
Are you at least 18 years of age?
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Yes
No
Do you have reliable transportation to work?
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Yes
No
Are you legally authorized to work in the United States?
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Yes
No
Are you able to perform the essential functions and duties of the position, with or without reasonable accommodations?
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Yes
No
If accommodations are needed, please explain
Have you ever been convicted of a crime?
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Yes
No
If yes, please explain
High School Name and Location
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Do you have your High School Diploma or GED?
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Yes
No
If no, highest grade completed
Did you attend College?
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Yes
No
Did you receive a degree?
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Yes
No
If yes, degree received?
Other Training (graduate, technical, vocational
Awards, Honors or Special Achievements
Please list any Certifications or Licenses
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Last Employer Name:
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Last Position:
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Dates of Employment:
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Are you currently employed there?
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Yes
No
Reason For Leaving/Reason For Applying:
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Please provide any other information that you believe should be considered:
Did someone refer you to seek employment with our Company?
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Yes
No
If yes, please tell us the name of who referred you
I certify that the information I have provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize the Company to contact my former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance and grades. I authorize the Company to contact the references I have listed, and I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my own choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of the Company, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship. I understand that if employment is offered and I accept the position, I must pass a criminal background check and drug screening before a written contract of employment is signed, and that I will not be able to begin working for the Company until then. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION, I UNDERSTAND AND AGREE TO ITS TERMS.
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Day
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Signature
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