1. Personal

Tell us about yourself.

• Name Referred By
• Email Address
• Applying For Full Time Part Time Temporary
• Position Retail Pharmacist Long Term Care Pharmacist Retail Pharmacy Technician Long Term Care Pharmacy Technician Billing/Accounts Receivable Clerk Custodian Delivery Driver Retail Sales Clerk Availability
• Address

  • Street Address Apt. No
  • City State Zip
• • Home Phone Best Time to Call
  • Mobile Phone Best Time to Call
• Pay Rate/Salary Desired
• Are you legally authorized to work in the U.S.? Yes No
• Are you at least 18 years old? Yes No
• If the position requires vehicle operation, do you have a valid driver's license? Yes No
• • Have you ever been convicted of a felony? Yes No
  • Do you have any pending criminal charges against you? Yes No
  • If Yes to either question, please explain:
    

2. Education

Name and Location	Type of Education	Years Completed
Graduated?
Unspecified Yes No
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3. Special Skills or Training

Describe skills you have that may qualify you to work with Lakeview Pharmacy

4. Employment History

Starting with your most recent position, list your employment history. Click the "Plus" button to add more positions.

From To Employer Job Title Supervisor Name Starting Salary / Wages ($) Final Salary / Wages ($) Phone City State Duties Reason For Leaving

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5. Upload Resume

Resume File

(Note: Uploaded file cannot be greater than 2MB. Must be in .doc or .pdf format)

6. Other Comments

If there's anything else you'd like us to know about you, please comment here.

APPLICANT'S CERTIFICATION

Please read the paragraphs below. By submitting this form, you certify that statements made by you on this form are true and correct and that you agree to the statements below.

STATEMENT OF DISCLOSURE: I certify that the information provided by me in this application is true and complete to the best of my knowledge. I understand that if I am employed by Lakeview Pharmacy, any false statements or omissions can lead to immediate dismissal. I agree that Lakeview Pharmacy will not be held liable in any respect if my employment is terminated for that reason. I authorize Lakeview Pharmacy to verify the information I have supplied. I understand and agree that if hired, my employment will not be for any fixed period of time and may be terminated at any time without prior notice and without cause; by Lakeview Pharmacy or me. I also understand that any offer of employment may be conditioned upon the results of a physical examination and/or drug test. I understand that this application will remain “active” for 60 days and if I want to be considered for employment beyond that time I must fill out another application.

DRUG SCREENING: I hereby agree to submit to a medical test for the presence of illegal drugs, alcohol, or prescription medication taken without a prescription. I will hold all parties concerned harmless, meaning I will not sue or hold anyone responsible for any alleged harm to me as a result of not submitting to the test or the reported results of the test. This includes, but is not limited to, possible clerical or laboratory error. I understand that Lakeview Pharmacy requires a post-offer pre-employment drug test and a drug/alcohol test whenever an employee is suspected of being under the influence of drugs or alcohol at work, or following an on-the-job accident or injury in accordance with Lakeview Pharmacy’s policy and this authorization and consent. Lakeview Pharmacy’s policy and this authorization and consent are in a language I understand and I understand that if I have questions I should ask a representative of Lakeview Pharmacy prior to submitting this form.

REFERENCE RELEASE FORM: I authorize Lakeview Pharmacy to investigate my character, qualifications, past employment, education, and activities. I release from all liability, any person, company, corporation, school, or government agency supplying such information. I understand that the employment information may include, but is not limited to, performance evaluations and reports, attendance records, job descriptions, disciplinary actions, and opinions regarding my suitability for employment. I recognize that a copy of this authorization and consent is as valid as the original and should be considered as such.