A P P L I C A T I O N
F O R
E M P L O Y M E N T
Date (Month, Day, Year) _____________________________
P E R S O N A L
Name ___________________________________________________________________________________________________________________________________________
Last
First
Middle
Present Address ________________________________________________________________________ Telephone Number (Area Code) ( ______ ) ___________________
Street Address
City
State
Zip Code
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Do you have the legal right to work in the United States?
Yes
No
Are you under the age of 18?
Yes
No
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Have you ever worked under a different name?
Yes
No If yes, list name and location below
_____________________________________________________________________ ____________________________________________________________________________
Name
Location
G E N E R A L I N F O R M A T I O N
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1. Have you ever visited a Rite Aid location?
Yes
No If yes, where? ______________________________________ Describe your experience: ______________________
____________________________________________________________________________________________________________________________________________________
2. Why would you like to work for Rite Aid? _______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
3. Describe a specific situation where you have provided excellent customer service in your most recent position. _________________________________________________
______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
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4. Were you referred by a Rite Aid associate?
Yes
No
If yes, name of associate: ____________________________________________________________________
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No If yes, explain: ________________________________________________
5. Have you ever been dismissed or forced to resign from any employment?
Yes
_______________________________________________________________________________________________________________________________________
P O S I T I O N A P P L I E D F O R
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IF THIS APPLICATION IS FOR A MANAGEMENT POSITION CHECK HERE
STORE MANAGER: Please forward MANAGEMENT APPLICATIONS to your Human Resources Manager.
Position ______________________________________________________ Location ________________________ Date you can start __________________________________
HOURS AVAILABLE
SUN
MON
TUE
WED
THU
FRI
SAT
MORNING
AFTERNOON
EVENING
E D U C A T I O N
NAME OF SCHOOL
YEARS
DIPLOMA OR DEGREE RECEIVED/
OVERALL
LOCATION (CITY, STATE, ZIP CODE)
COMPLETED
EXPECTED OR CREDITS EARNED
GPA
HIGH SCHOOL
UNDERGRADUATE COLLEGE
GRADUATE COLLEGE
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MILITARY
TRADE
OTHER
OVER
Form No. 21 Code No. 740416 (Rev. 5/11)