Damm Pharmacies is an equal opportunity employer.
Last Name First Name Middle Name Social Security Number
Street City State Zip Code Phone Number E-mail address Are you 18 years or older? YesNo Are you prevented from lawfully becoming employed in this country because of visa or immigration status? YesNo
Position Pharmacy TechnicianPharmacist Date you can start Salary desired Are you employed now? YesNo If so may we contact your present employer? YesNoN/A Referred by
Where do/did you attend high school? Did you graduate high school or receive a GED? YesNo Where do/did you attend college or trade school (if applicable)? What was your area of study (if applicable)? Did you graduate? YesNoN/A
Do you have any special skills? What is your current school schedule, if any? Please list days and times. Are you able to work Saturdays? YesNo Is there anything else you would like us to know about you? Have you had any moving traffic violations in the last two years? YesNo If yes, please describe and list dates. Do you agree to a pre-employment drug screen? YesNo
Please provide information on your last three employers starting with the the most current. Name and Address of Employer Employed From (month and year) To (month and year) Position Held Reason for Leaving Name and Address of Employer Employed From (month and year) To (month and year) Position Held Reason for Leaving Name and Address of Employer Employed From (month and year) To (month and year) Position Held Reason for Leaving Which of these jobs did you like best? What did you like most about this job?
Give the names of three persons not related to you, whom you have known for at least one year. Name Contact information (Address/Phone Number) How do you know this person? Years acquainted Name Contact information (Address/Phone Number) How do you know this person? Years acquainted Name Contact information (Address/Phone Number) How do you know this person? Years acquainted Please attach your CV or Resume (if applicable) "I certify that all of the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing." Electronic Signature
