Application For Employment Form - Rite Aid Pharmacy

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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
Do you have the legal right to work in the United States?
Yes
No
Are you under the age of 18?
Yes
No
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
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. _________________________________________________
______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
4. Were you referred by a Rite Aid associate?
Yes
No
If yes, name of associate: ____________________________________________________________________
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
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
MILITARY
TRADE
OTHER
OVER
Form No. 21 Code No. 740416 (Rev. 5/11)

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