Ross Drug Employment Application

Ross Drug Employment Application

Apply for employment at Ross Drug. All hiring decisions are based on qualifications only.
Ross Drug is an equal opportunity employer. All hiring decisions are based solely on qualifications, without regard to race, color, religion, sex, national origin, age, disability, or any other protected status.
Personal Data

Please provide your personal information.
Date*

MonthDayYear
Date
Full Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Cell/Business Phone*
Please enter a valid phone number.
Email Address*
example@example.com
Emergency Contact

Please provide details for an emergency contact.
Emergency Contact Name*

First NameLast Name
Emergency Contact Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Phone*
Please enter a valid phone number.
Eligibility & Identification

Please answer the following eligibility questions.
Are you under 18 years of age?*

YesNo
License Number or State ID Number*
Issuing State*
Have you ever been employed by Ross Drug before?*

YesNo
If yes, employment start date

MonthDayYear
Date
If yes, employment end date

MonthDayYear
Date
List friends or relatives employed by Ross Drug and relationship
Position Information

Tell us about the position you are applying for.
Position Applied For*
Date Available to Begin Work*

MonthDayYear
Date
Days Available to Work*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Hours Available to Work*
Are you able to work Saturdays when needed?*

YesNo
Proof of eligibility to work in the U.S. will be required upon employment.
Physical Data

Please answer the following regarding your physical ability to perform job duties.
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?*

YesNo
If no, please explain and describe any accommodations requested.
Military Data

Please provide your military service information if applicable.
Have you served in the military?*

YesNo
If yes, please provide branch, dates of service, and final rank.
Security Data

For security purposes, please answer the following.
Have you ever been convicted of a felony or misdemeanor?*

YesNo
If yes, please specify the offense and date.
Education Data

Please provide your educational background.
Education History*
Professional Certification

List any professional licenses or certifications.
Specialty
License Number
Present License Issue Date

MonthDayYear
Date
State
Expiration Date

MonthDayYear
Date
Have you applied for a GA license?

YesNo
Have you ever had a license revoked?

YesNo
If yes, please explain.
Special Training or Skills

List any additional relevant skills or training.
List office, mechanical, or medical training, certifications, and equipment/software experience.
Employment History

List your three most recent employers.
Employment History*
References

Provide three professional references.
References*
Why do you want to work at Ross Drug?
Agreement & Signature

Please read and sign below.
By submitting this application, I understand and agree that employment at Ross Drug is at-will, meaning either I or Ross Drug may terminate employment at any time, with or without cause or notice. I authorize Ross Drug to conduct background and reference checks as part of the hiring process. I agree to abide by all company policies, including maintaining a drug-free workplace and participating in any required drug testing. I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in the withdrawal of an offer or termination of employment. I further agree that any disputes arising from my employment will be resolved through binding arbitration, as permitted by law.
Date*

MonthDayYear
Date
Applicant Signature*

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Ross Drug Employment Application

Personal Data

Emergency Contact

Eligibility & Identification

Position Information

Physical Data

Military Data

Security Data

Education Data

Professional Certification

Special Training or Skills

Employment History

References

Agreement & Signature