Cornerstone Care Group Careers

Division Desired:*

Cheek & Scott Pharmacy • JasperCheek & Scott Pharmacy • Lake CityCheek & Scott Pharmacy • Live OakCheek & Scott Medical Equipment / Warehouse • Live OakCornerstone Care Clinic • Live Oak
Personal Information
Title:
Full Name*

First NameLast Name
E-mail*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Employment Desired
Position Desired:
Date you can start:

MonthDayYear
Salary Desired:
Are you Employed Now?

YesNo
May we inquire of your Present Employer?

YesNo
Current Employer (Company, Contact name, and phone number):
Are you Legally Authorized to work in the US?*

YesNo
Have you ever Applied to Cheek & Scott before?

YesNo
Please tell us about your previous application (how long ago, results, etc.):
Education History - High School
High School Name:
High School Location:
High School Years Attended:
High School Subjects Studied:
High School GPA:
Did you Graduate High School?

YesNo
Education History - College
College Name:
College Location:
Years Attended College:
College GPA:
Did you Graduate College?

YesNo
Degree(s) Earned:
Trade, Business, Correspondence, Technical, and other Schools and Certifications:
General Information
Subjects of special study, research, &/or work:
Special Training:
Special Skills:
Military Service (include rank, and status of discharge):
Current/Former Employer (1 of 3)
Name of Employer:
Address of Employer:
Phone number of Employer:
Position:
Salary:
Date Started:

MonthDayYear
Date Ended:

MonthDayYear
Reason for Leaving:
Former Employer (2 of 3)
Name of Employer:
Address of Employer:
Phone number of Employer:
Position:
Salary:
Date Started:

MonthDayYear
Date Ended:

MonthDayYear
Reason for Leaving:
Former Employer (3 of 3)
Name of Employer:
Address of Employer:
Phone number of Employer:
Position:
Salary:
Date Started:

MonthDayYear
Date Ended:

MonthDayYear
Reason for Leaving:
References (1 of 3)
Name:
Relationship:
Phone #:
Email:
Business:
Address:
Years Known:
References (2 of 3)
Name:
Relationship:
Phone #:
Email:
Business:
Address:
Years Known:
References (3 of 3)
Name:
Relationship:
Phone #:
Email:
Business:
Address:
Years Known:
Authorization

I certify that the facts contained are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release Cornerstone Care Group, Inc. from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of Cornerstone Care Group, Inc. has any authority to enter into an agreement for employment for an specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Cornerstone Care Group representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant state and federal laws. Cornerstone Care Group, Inc. is an Equal Opportunity Employer.
Signature*

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