Columbus Day News

TRIANGLE PHARMACY & ACE Employment Application Thank you for your interest in employment with our company. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. (Please Print) Date Position(s) Applied For How Did You Hear About Us? Advertisement Employee Referral Friend Walk-In Other Last Name First Name Middle Initial Address City State Zip Code Phone Number Email Address Social Security Number (Required for payroll purposes if hired) Best time to contact you at home AM PM May we contact you at your place of employment? YES NO If yes, please provide number: Are you currently employed? YES NO If not, how long since last employment? Are you on layoff status? YES NO Have you ever worked for this company before? YES NO If yes, when? Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment. YES NO On what date would you be available for work? Are you available to work: Full Time Part Time Shift Work Temporary Are you willing to work overtime if necessary? YES NO Do you possess a valid Driver’s License? YES NO Driver’s License Number State Have you had any accidents within the last three years? YES NO If yes, please explain: Have you had any traffic violations within the last three years? YES NO If yes, please explain: EDUCATION School Name Location Course of Study Years Completed Diploma/Degree YES NO YES NO YES NO YES NO YES NO YES NO High School College Vocational Other SKILLS AND QUALIFICATIONS - Summarize any special skills and qualifications acquired from employment or other experience that may qualify you for work with our company. EMPLOYMENT EXPERIENCE - Start with your present or last job. Include military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Employer Phone Number Address City State Zip Code Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Employer Phone Number Address City State Zip Code Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Employer Phone Number Address City State Zip Code Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO REFERENCES - Give name, phone number and address of three references who are not related to you and are not previous supervisors. Name Phone Number Address City, State, Zip Code Name Phone Number Address City, State, Zip Code Name Phone Number Address City, State, Zip Code In case of emergency, who should be notified? Name Relationship Phone Number Address City State Zip Code SKILLS AND ABILITIES - Please list any skills and abilities you possess that you feel can be used in the position for which you are applying. AVAILABILITY - Please list the days and hours you are available to work. DESIRED COMPENSATION - What are your salary or wage requirements? Please read carefully: I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the company to verify the information provided in this application, including contacting previous employers and references. I release the company from any liability in connection with such verification. I understand that this application is not a contract of employment, and that employment with the company is at-will, meaning that either the employee or the company may terminate the employment relationship at any time, with or without cause or notice. I acknowledge that I have read and understand the above statements. Signature Date