Application For Employment

Application For Employment

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis includingage, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does notprohibit performance of essential job functions.
Date

MonthDayYear
Date
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Federal Law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time will result in immediate employment termination.
Is there any information about your name or use of another name that we would need to check your work record? If so, please specify.
Position applying for:
Do you have any relatives who are presently, or who were formerly, employed by Smith’s Drugs? Please list below:
How were you referred to Smith’s Drugs?
Have you ever been convicted of a felony?

YesNo
If yes, please explain:

	Educational History	School Name	Years Completed	Diploma or Degree	YearGraduated/Completed(MMYYY)
Elementary
High School
College
Graduate School
TechnicalTraining
Other

Employment Record

*Please list all employment for the last five years, with the most recent first. Use a separate sheet to list additional employers if necessary. Fill out any dates in the following format: MM/YY.
Name of Company
Phone Number
Please enter a valid phone number.
Address:
Position Held:
Start Date:
End Date:
Reason For Leaving:
Manager:
Name of Company
Phone Number
Please enter a valid phone number.
Address:
Position Held:
Start Date:
End Date:
Reason For Leaving:
Manager:
Name of Company
Phone Number
Please enter a valid phone number.
Address:
Position Held:
Start Date:
End Date:
Reason For Leaving:
Manager:
Name of Company
Phone Number
Please enter a valid phone number.
Address:
Position Held:
Start Date:
End Date:
Reason For Leaving:
Manager:
Name of Company
Phone Number
Please enter a valid phone number.
Address:
Position Held:
Start Date:
End Date:
Reason For Leaving:
Manager:
References

*Please do not include family members
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Years Known:
Relationship:
Occupation:
Address:
Email
example@example.com
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Years Known:
Relationship:
Occupation:
Address:
Email
example@example.com
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Years Known:
Relationship:
Occupation:
Address:
Email
example@example.com
Work Availability
If your application receives favorable consideration, when would you be available to begin work?
Do you have any objection to working overtime?

YesNo
Do you have any objection to working on-call hours?

YesNo
Can you work on Saturday?

YesNo
Can you work on Sunday?

YesNo
Can you travel if required for this position?

YesNo
Do you have transportation back and forth from work?

YesNo
If you are finished with High School, will you be continuing your education further?

YesNo
Salary Requirements
If your application receives favorable consideration, what salary/hourly rate would you require?
Should be Empty: