|
What position are you applying for?*
|
|
|
|
|
|
|
|
Personal Information
|
| Do you currently possess a valid state issued picture identification (driver's license, passport etc): *
|
|
| Are you willing to take a pre-employment drug test? *
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Do you currently use tobacco in any form including but not limited to: cigarettes, dip, chew etc? *
|
|
| Are any of your relatives or friends presently employed with the company or it's divisions? If yes, list name of relative(s) or friend(s) and relationship: *
|
|
|
|
| Have you ever applied for the company or it's divisions before? *
|
|
|
|
| Have you ever worked for the company or it's divisions before? *
|
|
|
|
| Can you perform the essential functions of the position for which you are applying for? *
|
|
|
|
|
|
| If under 18 years of age, can you supply working papers? *
|
|
| Only U.S. citizens and/or aliens who have a legal right to work in the U.S., are eligible for employment. Can you, upon employment, provide genuine documentation establishing your identity and eligibility to be legally employed in the United States? *
|
|
Have you ever been convicted of a crime or violation other than a minor traffic infraction? A conviction record will not necessarily be a bar to employment. Factors such as job relations, age and time of the offense, seriousness and nature of violation and rehabiliation will be taken into account. If yes, please exlpain below. If no, please skip next section. |
|
|
| Have you ever been discharged from any employment or asked to resign? If yes, please explain below: *
|
|
|
|
Availability and Requirements |
| Please check which days you are available to work.: *
|
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
|
| Are you available to work:*
|
AM
PM
|
|
|
|
|
|
|
Education History |
|
|
| Have you graduated high school? |
|
|
|
| Did you graduate college? |
|
|
|
|
|
Employment History:Begin with your most recent employment and continue with all past employment. |
|
|
|
|
|
|
|
Personal and/or Professional ReferencesPlease list below references including their name, phone number, relationship and years acquainted. |
|
|
|
|
|
|
Attendance and Punctuality Information |
| Consistent attendance and punctuality are essential requirements of every job with this company. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with the organization? If yes, please explain below: *
|
|
|
|
I certify that all of the information herein is true and correct. I understand and agree that if employed, false, misleading or incorrect statements or material omissions on this application may be sufficient cause for termination at any time and that the Star Discount Pharmacy shall not be liable in any respect if my employment is terminated. I acknowledge that employment with the Star Discount Pharmacy is “at will” and either the Star Discount Pharmacy or I may terminate the employment relationship at any time, with or without cause. I authorize the Star Discount Pharmacy or its agent(s) to investigate all information on this application. I further authorize the Star Discount Pharmacy or its agent(s) to make investigative inquiries and obtain reports such as motor vehicle driving record, criminal background check, or any other inquiries or reports as the Star Discount Pharmacy deems necessary.
IT IS THE POLICY OF THE COMPANY TO AFFORD EQUAL OPPORTUNITY TO ALL EMPLOYEES AND APPLICANTS FOR EMPLOYMENT WITHOUT REGARD TO AGE, RACE, RELIGION, COLOR, SEX, NATIONAL ORIGIN, MARITAL STATUS, EXPUNGED JUVENILE RECORDS, OR PREGNANCY, AND TO AFFORD EQUAL OPPORTUNITIES TO DISABLED VETERANS, VETERANS OF THE VIETNAM ERA, AND INDIVIDUALS WITH A DISABILITY, ANY AND OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE OR LOCAL LAW.
I AUTHORIZE THE INVESTIGATION OF ALL STATEMENTS AND INFORMATION CONTAINED IN THE APPLICATION. I RELEASE FROM ALL LIABILITY ANYONE SUPPLYING SUCH INFORMATION AND I ALSO RELEASE THE EMPLOYER FROM ALL LIABILITY THAT MIGHT RESULT FROM MAKING AN INVESTIGATION.
IF HIRED, I AGREE TO ABIDE BY ALL OF THE COMPANY RULES AND REGULATIONS, AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT THE OPTION OF EITHER THE COMPANY OR ME, I FURTHER UNDERSTAND THAT NO REPRESENTATION, WHETHER ORAL OR WRITTEN BY ANY REPRESENTATIVE OR AGENT OF THE COMPANY, AT ANY TIME, CAN CONSTITUE A CONTRACT OF EMPLOYMENT. I UNDERSTAND THAT THE COMPANY AND ALL PLAN ADMINISTRATORS SHALL HAVE THE MAXIMUM DISCRETION PERMITTED BY LAW TO ADMINISTER, INTERPRET, MODIFY, DISCONTINUE, ENHANCE OR OTHERWISE CHANGE ALL POLICIES, PROCEDURES, BENEFITS OR OTHER TERMS OR CONDITIONS OF EMPLOYMENT. NO REPRESENTATIVE OR AGENT OF THE COMPANY, HAS THE AUTHORITY TO ENTER INTO ANY AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME OR TO MAKE ANY CHANGE IN ANY POLICY, PROCEDURE, BENEFIT OR OTHER TERM OR CONDITION OF EMPLOYMENT OTHER THAT IN A DOCUMENT SIGNED BY THE PRESIDENT OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE STATEMENTS AND HEREBY GRANT PERMISSION TO CONFIRM THE INFORMATION SUPPLIED ON THIS APPLICATION BY ME. BY SELECTING AGREE AND SUBMITTED APPLICATION I AGREE TO ALL OF THE INFORMATION I HAVE GIVEN IS ACCURATE:
|
|
|
|
|
|
|
| |