Employment – Rocky Point Pavilion Pharmacy

Employment Applicaton

General Informaton

Employment Application

Name

(Last, First, Middle)

Phone Number

Street Address *

City *

State *

ZIP *

Social Security Number

Are you legally allowed to work in the U.S.:

Have you ever been convicted of a felony? *

If yes to the above question, please explain

Employment History

Employment History - Begin with most recent employment

May we contact your present employer?

Company Name

Dates worked from and to

City, State

Please explain your Title and Duties

Reason for Leaving

Supervisor's Name

Phone Number

Company Name

Dates worked from and to

City, State

Please explain your Title and Duties

Reason for leaving

Supervisor's Name

Phone Number

Education/Training

Education/Training - Include Technical/Academic Achievements/Courses

Have you obtained a high school diploma or GED certificate?

High School Name and Location

Diploma/Degree

Subjects Of Specialization

College/University Name and Location

Diploma/Degree

Subjects Of Specialization

Specialized Courses & Training Name and Location

Degree/Diploma

Subjects Of Specialization

Job Specific

Job Desired Related Information

Position Desired?

Salary Desired?

Have you ever applied for employment with us before?

How were you referred?

Are you acquainted with or related to any of our employees?

If Yes, identify by name and relationship

Have you ever been fired from or asked to leave a job?

If Yes, please explain

Do you smoke cigaretts?

Do you speak any language other than English?

If yes, what language?

Date available to work?

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