Employment Application

Employment Application

Please complete this form to apply for employment. All information will be kept confidential.
Date

MonthDayYear
Date
Position Applied For
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date Available to Start

MonthDayYear
Date
Are you seeking Full-time or Part-time employment?
Are you a citizen of the United States?
If under 18, can you provide a work permit?
Have you ever pled guilty or no contest, or been convicted of a crime?
If yes, please explain.
Education
High School Name
High School Address
Did you graduate from High School?
Number of years completed (High School)
College or University Name
College or University Address
Did you graduate from College or University?
Number of years completed (College/University)
Major (College/University)
References
Reference 1 Name
Reference 1 Address
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1: Personal or Professional?
Reference 2 Name
Reference 2 Address
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2: Personal or Professional?
Reference 3 Name
Reference 3 Address
Reference 3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3: Personal or Professional?
Previous Employment
Dates of Employment
Place of Employment
Employment Address
Employment Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Held
Responsibilities
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer?
Supervisor's Name
Dates of Employment
Place of Employment
Employment Address
Employment Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Held
Responsibilities
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer?
Supervisor's Name
Dates of Employment
Place of Employment
Employment Address
Employment Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Held
Responsibilities
Starting Salary
Ending Salary
Reason for Leaving
May we contact this employer?
Supervisor's Name
I certify that my answers are true and complete to the best of my knowlege. I authorize Buy-rite Drugs to make such investigations and inquiries of my personal, employment and educational history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application.
In the event that I am employed, I understand that false or misleading information given in my application or interview may result in discharge.
Should be Empty:

Employment Application

Education

References

Previous Employment