Personal Information

Desired Employment

Are you 18 years of age or older? YesNo
Are you employed now? YesNo
If so, may we inquire of your present employer? YesNo
Are you legally authorized to work in the US? YesNo
Have you ever applied to this company before? YesNo

Education History

HIGH SCHOOL

Did you graduate? YesNoN/A

COLLEGE

Did you graduate? YesNoN/A

OTHER

Did you graduate? YesNoN/A

General Information

Employment History

Reason for Leaving

Reason for Leaving

Reason for Leaving

Reason for Leaving

Personal & Employment References

List three references not related to you that you have known at least one year.

Additional Information

Within the past five years, have you been convicted of a felony, or within the past two years, of any misdemeanor or are you presently formally charged with committing a criminal offense? (Do not include any traffic violations, juvenile offenses or military convictions, except by general court-martial.)*YesNo
If the answer is yes, furnish details of the conviction, offense, location, date, and sentence:
In the past three years, have you ever knowingly used any narcotics, amphetamines, or barbiturates other than those prescribed to you by a physician?*YesNo
If the answer is yes, furnish details:

Authorization

EVALUATION Information about you furnished or recovered as a result of any inquiry will not necessarily preclude employment, but will be considered as part of an overall evaluation of your qualifications.

PRIVACY In keeping with fair employment practices and the protection of your right of privacy, the results of inquiries conducted in connection with this application will be held in confidence by this pharmacy.

By entering my name in the signature field below, I certify that all of my answers and statements on this application are true and complete to the best of my knowledge. I understand that if an inquiry discloses that any of my answers or statements are untrue or misleading, my application may be rejected or, if I am employed by the pharmacy, my employment may be terminated. I also understand that if I am employed by the pharmacy, my employment will be "at will" and my employment may be terminated with or without cause at any time at the option of the pharmacy.

Savage’s Drug is an equal opportunity employer. It is our policy to afford equal employment opportunity and advancement opportunity for all qualified individuals without distinction or discrimination because of race, religion, ethnicity, national origin, disability, age, sexual orientation, gender and/or other basis prohibited by applicable law.

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