This application will remain current for a period of 30 days.

Please complete this application form and answer or acknowledge every question.

EMPLOYMENT APPLICATION

"Prospective employees will receive consideration without discrimination because of race, color, creed, sex, marital status, age, national origin or ancestry, physical or mental disability, medical condition, sexual orientation, or any other consideration made unlawful by federal, state or local laws." "We are a drug free workplace."

PERSONAL INFORMATION
Are you atleast 18 years old?
Are you atleast 16 years old?
If you are under 18, you will be required to provide a work permit upon employment
Are you legally eligible for employment in this country?
Proof of U.S. citizenship or immigration status will be required upon employment.
JOB INTEREST & AVAILABILITY
Pharmacy Location are you applying to? *
Position Desired :
Schedule Desired :
Weekly Hours Worked, At Your Previous Jobs:
1. hours 2. hours 3. hours 4. hours
Maximum hours you are willing to work per week * :
Days & Hours You Are Available Per Work Weekly :
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Daily Driving Distance :

If required by the job would you be willing to commute?

If yes, How Far? Miles
Based on your understanding of the duties of the job you are applying for, are you able to perform these duties with or without accommodation?
If you will need accommodation, please specify below:

Has Pharmacy Boardhop ever employed you?

If yes, When?
Available Starting Date * :
Salary Desired * :
EDUCATIONAL BACKGROUND
High School

Name & Location of School?

Major/Area Of Study :

Number Of Years :

Graduated/GPA :

College

Name & Location of College?

Major/Area Of Study :

Number Of Years :

Graduated/GPA :

Other

Name & Location of Other?

Major/Area Of Study :

Number Of Years :

Graduated/GPA :

SKILLS AND QUALIFACTION

Summerize special skills and qualifications acquired from employment, membership in professional organization or other experiences that may qualify you for work with Pharmacy Boardshop (i.e. computer, keyboard, register, software etc.) *

ADDITIONAL QUESTIONS

Summerize special skills and qualifications acquired from employment, membership in professional organization or other experiences that may qualify you for work with Pharmacy Boardshop (i.e. computer, keyboard, register, software etc.)

EMPLOYMENT HISTORY

List employment starting with the most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities. If you have less than four places of employment, please include personal references to be contacted. If you have more than four places of employment, please list on a separate piece of paper.

PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I un- derstand that omission or misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejec- tion of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Pharmacy Boardshop to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to Pharmacy Boardshop any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Pharmacy Boardshop, my former employers and all other persons, corporations partnership and associations from any and all claims, demands or liabilities arising of or in any way related to such an investigation or disclosure.

I understand that nothing that contains in the application, or conveyed during any interview, which may be granted, or during my employment, if hired is intended to create an employment contract between Pharmacy Boardshop and me. I understand that, if hired, I may be transferred, reassigned, sus- pended or demoted. In addition, I understand and agree that if I am employed, my employment will be At-Will and is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Pharmacy Boardshop, and that no promises or representations contrary to the foregoing are binding on Pharmacy Boardshop unless made in writing and signed my me and Pharmacy Boardshop representatives.