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Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 months.
Pharmacy Technician (Registry)

The Pharmacy Technician is responsible for preparing for dispensing unit dose medications and IV admixtures, medication delivery rounds to nursing units, medication charge/credits, ordering, receiving and checking drug inventory, etc. 

Job Posting Select Posting to Apply for: 
Pharmacy Technician (Registry)
Personal Information
First Name*:
Middle Name:
Last Name*:
Home Phone:
Work Phone:
Cell Phone:
Email Address*:
Current Address
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
Prior Address (1)
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
Prior Address (2)
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
High School
School:
City:
State:
Diploma:
Undergrad School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:
Grad School
School:
City:
State
Diploma:
Deg/Cert/Dip:
Area of Study:
Other School
School:
City:
State:
Diploma:
Deg/Cert/Dip:
Area of Study:
Employment Information
Position Applied For:
Date You Can Start:
calendar (yyyy-mm-dd)
Do You Prefer:
Can you work:
 Weekends
 Evenings
Available:
 M
 Tu
 W
 Th
 F
 Sa
 Su
Not Available:
Please answer all of the following questions.
1.
Are you at least 18 years of age and legally eligible to work for our company in the United States?
2.
Have you worked for this business before?
 
If yes, please provide dates and locations.
 
3.
Do you understand the job requirements?
 
If no, please explain.
 
4.
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
 
If yes, please explain...
 
Employer
May we contact your present employer?
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (1)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (2)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (3)
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Job-related Skills
Reference (1)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (2)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (3)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (4)
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Resume (Text Version)
 
Copy and Paste a text version of your resume here.
 
Upload File
 
Attach a file to your application submission
 
Applicant's Certification Agreement
1.
I understand that employment requires proof of eligibility to work in the United States according to the Immigration Reform and Control Act of 1986 and I will be able to provide the needed documentation to prove my identity and eligibility upon hire.
2.
I certify that the information contained in my application materials (e.g. the application, my resume, any additional documentation) is true and correct to the best of my knowledge and belief. I further understand and agree that any misrepresentation, omission, or falsification of information provided in this application constitutes grounds for immediate dismissal from any subsequent employment at Holy Cross Hospital. I hereby authorize Holy Cross Hospital to verify my past and present employment, education, and other activities and entities as are related to these application materials. I agree to cooperate in such inquiry and hereby release Holy Cross Hospital from all responsibility or liability. I agree to submit to such pre-employment tests as may be deemed necessary by Holy Cross Hospital and I understand that successful completion of such tests is in accordance with standards established by the Hospital.
3.
I hereby authorize my past and present employers, schools, institutions, and all individuals, partnerships, associations, or corporations and any other references to provide any information they may have regarding me. I hereby release them and their organizations from all liability, claims, and causes of action for issuing the same.
4.
I understand that should an employment offer be extended to me and accepted, that I will fully adhere to the policies, rules, and regulations of employment. However, I further understand that neither the policies, rules, nor regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and “at will” and that either I or Holy Cross Hospital may terminate my employment at any time with or without notice or cause. By my signature, I acknowledge that I have read and understand the above statements.
 
Security Code
 
Security Code
 
 
Signature
 
Type Name in Signature Box:
 
 
Today's Date: 2013-05-18 13:29:18

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