Fisherville Pharmacy Job Application

Fisherville Pharmacy Application for Employment
Personal Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Have you ever been convicted of a felony or misdemeanor? If yes please provide additional information below.

YesNo
Please state the nature of offense, date, city, state and disposition. Please note that this will not necessarily affect your application but is necessary due to NH Board of Pharmacy regulations.
Are you over 18 years of age?

YesNo
If you answered no to the above question, when will you be 18?
Position Sought:
Available Start Date

MonthDayYear
Date
Desired Pay Range
Are you currently Employed?
Education

Type a question

	Name and Location	Graduate?- Degree?	Major/Subjects of Study
High School
College or University
Specialized Training, Trade School, Etc.
Other Education

Please list your areas of highest proficiency, special skills, or other items that may contribute to your abilities in performing the above mentioned position.
References

List three personal references, not related to you, who have known you for more than one year.
Name
Phone Number
Please enter a valid phone number.
Years Known
Address
Name
Phone Number
Please enter a valid phone number.
Years Known
Address
Name
Phone Number
Please enter a valid phone number.
Years Known
Address
Please Read Before Signing:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.
Signature

Clear
Date

MonthDayYear
Date
Previous Work History

Please list beginning from most recent
If you have a resume and would prefer to upload it instead of filling out the information below please do so.

Cancelof
Dates Employed
Company Name
Location
Role/ Title
Job notes, tasks performed and reason for leaving:
Dates Employed
Company Name
Location
Role/ Title
Job notes, tasks performed and reason for leaving:
Dates Employed
Company Name
Location
Role/ Title
Job notes, tasks performed and reason for leaving:
Dates Employed
Company Name
Location
Role/ Title
Job notes, tasks performed and reason for leaving:
Should be Empty:

Fisherville Pharmacy Application for Employment

Personal Information

Education

References

Previous Work History