• Application and Drug Free Workplace Policy

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  • Are You Willing To Work:
  • Indicate Applicable Work Skills:
  • Please list name, address, and phone number of previous employers with most recent employers first. Periods of unemployment should be included.

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  • Please list three references (not relatives or employers) to contact who are acquainted with your work history.

  • I authorize you, at the time of my application for employment or during the course of my employment, to obtain information from any source as to my education, experience, competence, character or medical history, as it relates to the position for which I applied or in which I may be employed unless otherwise stated. I ceretify that the information contained in this application is tru, complete, and correct to the best of my knowledge and belief. I understand that any falsification or omission of information may cause my immediate dismissal or rejection of this application. I agree that all statements made in this application may be investigated. I also understand that I may be required to successfully complete a medical exam for initial and continued employment. I further understand that in the event I am employed, such employment is at will. Neither I nor the employer have agreed on any specific period of employment nor any specific pay or benefits otherwise set forth in a separate contract.

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  • DRUG FREE WORK PLACE POLICY

  • RelyCare Pharmacy is committed to providing an employment environment that is safe and provides appropriate motivation to ensure a creative and productive work force. RelyCare Pharmacy endorses the philosophy that the work place should be free from the detrimental effects of illicit drugs. To ensure worker safety and work place integrity, RelyCare Pharmacy prohibits the illegal manufacture, possession, distribution, or use of controlled substances by its employees or those who engage or seek to engage in business with RelyCare Pharmacy.

    In an effort to assure employees of a work place free from illegal drugs and their effects, RelyCare Pharmacy will implement the following Drug Free Work Place Policy:

    1. Policy: It is unlawful to illegally manufacture, distribute, dispense, possess, or use a controlled

    2. Procedures

    a. It is the policy of the pharmacy that all employees and each new hire will receive a drug screening when hired and at random intervals during their term of employment with RelyCare Pharmacy.

    b. Each employee will review a copy of the Drug Free Work Place Policy stating it is unlawful to illegally manufacture, distribute, dispense, possess, or use a controlled substance. Each employee will sign and date the statement certifying that she/he:

    1. Understands and will abide by the Drug Free Work Place Policy;

    2. Has knowledge of disciplinary actions which may be imposed for violations of the Drug Free Work Place Policy. The signed and dated statement will be forwarded to the individual in charge of personnel records. The signed and dated statement will be permanently part of the employee's personnel file.

    3. Disciplinary Action:

    a. If an employee is convicted of violating any criminal drug statue she/he will be subject to

    b. If an employee fails a drug screening test, they will be subject to immediate termination.

    c. An employee is required to report within five days any criminal drug statue conviction.

  • I certify that I have read this Drug Free Work Place Policy and agree to comply with it.

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