Application For Employment Form - Rite Aid Pharmacy Page 2
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4E M P L O Y M E N T & E X P E R I E N C E
EMPLOYER AND LOCATION
POSITION TITLE AND
STARTING RATE
REASON FOR
STREET ADDRESS, CITY, STATE, ZIP
IMMEDIATE SUPERVISOR
ENDING RATE
LEAVING
FROM MO/YR
EMPLOYER (present or most recent)
YOUR TITLE
$
______________ ADDRESS
SUPERVISOR
TO MO/YR
❒
❒
MAY WE CONTACT?
YES
NO
$
TELEPHONE NUMBER
______________
FROM MO/YR
EMPLOYER
YOUR TITLE
$
______________ ADDRESS
SUPERVISOR
TO MO/YR
❒
❒
MAY WE CONTACT?
YES
NO
$
TELEPHONE NUMBER
______________
FROM MO/YR
EMPLOYER
YOUR TITLE
$
______________ ADDRESS
SUPERVISOR
TO MO/YR
❒
❒
MAY WE CONTACT?
YES
NO
$
TELEPHONE NUMBER
______________
FROM MO/YR
EMPLOYER
YOUR TITLE
$
______________ ADDRESS
SUPERVISOR
TO MO/YR
❒
❒
MAY WE CONTACT?
YES
NO
$
TELEPHONE NUMBER
❒
❒
HAVE YOU EVER WORKED FOR RITE AID?
Yes
No
IF YES DATES OF EMPLOYMENT __________________________________________ REASON FOR LEAVING _______________________________________________________
______________________________________________________________________________________________________________________________________________________
P H A R M A C I S T S , P H A R M A C Y T E C H N I C I A N S & P H A R M A C Y I N T E R N S O N LY
Registered States
________________ License Number ______________________________________
________________ License Number ______________________________________
________________ License Number ______________________________________
❒
❒
Have you ever had or do you currently have any restrictions on your license?
Yes
No
If yes, explain below.
_____________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________
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Parent category: Business