Employment Application

Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital, veteran status, vaccination status, or the presence of a non-job-related medical condition or handicap.

First Name

Last Name

Maiden Name

Mailing Address

Physical Address

Telephone

Referred By

Are you a U.S. Citizen?

Date of Birth

Are You Currently Employed?

Where?

Date you can start?

Desired Salary?

Do you have relatives are employed here?

If Yes, What are their names?

Can you work weekends?

Can you work summer weekends?

Do you have any physical limitations?

Dust or perfume allergies?

Back or foot problems?

Are you willing to be drug tested?

Have you used a cash register?

Can you count cash back?

Do you have any special skills or qualifications related to the postition applied for?

In the last five years, have you been convicted of a felony or misdemeanor that would make this job inappropriate?

What was the reason?

High School Attended

Date Graduated

College Attended

Date Graduated

Name of First Reference

Phone Number Of First Reference

Name of Second Reference

Phone Number Of Second Reference

Name of Third Reference

Phone Number Of Third Reference

Emergency Contact

Emergency Contact Phone Number

Business Name

City & State

Start Date

Leave Date

Position

Wage

Reason for leaving

Contact Person Name

Contact Person Phone Number

Business Name

City & State

Start Date

Leave Date

Position

Wage

Reason for leaving

Contact Person Name

Contact Person Phone Number

Business Name

City & State

Start Date

Leave Date

Position

Wage

Reason for leaving

Contact Person Name

Contact Person Phone Number

Business Name

City & State

Start Date

Leave Date

Position

Wage

Reason for leaving

Contact Person Name

Contact Person Phone Number

Employment Application

Get In Touch

417 S Tower Ave Centralia, WA 98531

Mon-Fri: 9:30am - 6:00pm
Sat: 10:00am - 2:00pm

(360) 736-5000

contact@centraliapharmacy.com

Proud Partners with

Copyright © 2021-2023 Centralia Pharmacy Designed by Spot N Designs | Custom images taken by RH Portraits
All images on this site are only for display purposes and not to represent how a pharmacy operates.

Employment Application

Get In Touch

417 S Tower Ave Centralia, WA 98531

Mon-Fri: 9:30am - 6:00pm Sat: 10:00am - 2:00pm

(360) 736-5000

contact@centraliapharmacy.com

Proud Partners with

Copyright © 2021-2023 Centralia Pharmacy Designed by Spot N Designs | Custom images taken by RH Portraits All images on this site are only for display purposes and not to represent how a pharmacy operates.

Mon-Fri: 9:30am - 6:00pm
Sat: 10:00am - 2:00pm

Copyright © 2021-2023 Centralia Pharmacy Designed by Spot N Designs | Custom images taken by RH Portraits
All images on this site are only for display purposes and not to represent how a pharmacy operates.