Application for Employment
Bowen Pharmacy
Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
Date
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Month
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Day
Year
Date
Name
First Name
Middle Initial
Last Name
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone
Format: (000) 000-0000.
Social Security #
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)
Yes
No
Are you looking for full-time employment?
Yes
No
If no, what hours are you available?
Have you ever been convicted of a felony? (This will not necessarily affect your application.)
Yes
No
If yes, please describe conditions.
Employment Desired
Position applied for
How did you hear of this opening?
Have you ever applied for employment here?
Yes
No
When?
Where?
Have you ever been employed by this company?
Yes
No
When?
Where?
Are you presently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you available for full-time work?
Yes
No
Are you available for part-time work?
Yes
No
Date you can start
Desired position
Desired starting salary,
Please list applicable skills
Education
Education
Rows
Year
Major
Degree
High School
College
College
Other Training
In addition to your work history, are there are other skills, qualifications, or experience that we should consider?
Employment History (Start with most recent employer)
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone
Format: (000) 000-0000.
Date Started
Starting Wage
Starting Position
Date Ended
Ending Wage
Ending Position
May we contact?
Yes
No
Responsibilities
Back
Next
(Employment History Continued)
Reason for leaving
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Started
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Month
-
Day
Year
Date
Starting Wage
Starting Position
Date Ended
-
Month
-
Day
Year
Date
Ending Wage
Ending Position
May we contact?
Yes
No
Responsibilities
Reason for leaving
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Started
-
Month
-
Day
Year
Date
Starting Wage
Starting Position
Date Ended
-
Month
-
Day
Year
Date
Ending Wage
Ending Position
May we contact?
Yes
No
Responsibilities
Reason for leaving
References
List three personal references, not related to you, who have known you for more than one year.
Name
Phone
Format: (000) 000-0000.
Years Known
Address
Name
Phone
Format: (000) 000-0000.
Years Known
Address
Name
Phone
Format: (000) 000-0000.
Years Known
Address
Please Read Before Signing:
I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.
I authorize Osborn Drugs, Inc. and/or its partner locations to check my references.
In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.
I understand that employment at this company is "at will," which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.
Signature
Date
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Year
Date
DO NOT WRITE BELOW THIS LINE
Interviewed By
Date
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Month
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Day
Year
Date
Remarks
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