Employment Application
 
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We are an equal opportunity employer. Federal and state laws prohibit discrimination in employment practices based on race, color, religion, sex, age, handicap, disability, or national origin. No question on this application is asked for the purpose of limiting or excluding any applicant's consideration for employment because of his or her race, color, religion, sex, age, handicap, disability, or national origin.


ATTENTION Yahoo! E-Mail Users: Our E-Mail Server no longer accepts employment applications from Yahoo! e-mail addresses. Please apply using our downloadable Employment Application (click here to download) and mail to us via our mailing address: Preferred Pharmacy Solutions, LLC., Attention: Human Resources, 35 Avco Road, Haverhill, Massachusetts 01835.


E-MAIL ADDRESS
E-Mail Address:  


POSITION
Facility:  
Position Desired:  
If Other, indicate position you are applying:  
Hours Desired:  
Salary Expected:  
 
Note:  If you do not remember the Job Code for the job your are applying, please use your browser back button to retrieve it


Last Name
 Middle Name
 First Name
 Social Security No.
 Telephone No.


Address
 Street
 City
 State
 Zip Code


If your records may be under a name other
than indicated above, please specify:
Licensed Pharmacists Only
Mass. Reg. No


Last Renewal
 Date Granted


Expiration Date


 Are you a citizen of the United States?
   If you are not a U.S. Citizen, do you have the
legal right to remain permanently in the United States?


Explain:


Are you between the age of
18 and 70?
   Do you know of any fact that would limit or impair your
ability to perform the functions of the job you are applying for?


Explain:



 Specialized training or experience not shown below:


Where now employed?
  Reason for desiring change:


IN CASE OF EMERGENCY NOTIFY
Name:  
Relationship:  
Address:  
Telephone:  


EDUCATION
Name and Location of School or College
  Major Subject
Graduated?
 Degree
 Attended From
 Attended To
       
       
Name and Location of School or College
  Major Subject
Graduated?
 Degree
 Attended From
 Attended To
       
       
Name and Location of School or College
  Major Subject
Graduated?
 Degree
 Attended From
 Attended To
       


FORMER EMPLOYERS AND EXPERIENCE (References)
Name and Address
 Nature or Experience
From
 To
 Salary
 Reason for Leaving
       
       
Name and Address
 Nature or Experience
From
 To
 Salary
 Reason for Leaving
       
       
Name and Address
 Nature or Experience
From
 To
 Salary
 Reason for Leaving
       


PERSONAL REFERENCES (Not Relatives)
Name:  
Address:  
Phone:  
Title:  
Business:  
   
   
Name:  
Address:  
Phone:  
Title:  
Business:  


COVER LETTER
You may "cut and paste" your cover letter in the box below.


RESUME
You may "cut and paste" your resume in the box below.


ANY ADDITIONAL INFORMATION?


SUBMIT YOUR APPLICATION:
* I authorize the schools, employers, and individuals listed in this application to release any information regarding my previous employment, character, general reputation and personal characteristics:



"It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability."
 
 
I certify that the statements I have made in this application are true and hereby grant the employer permission to verify that accuracy and completeness of this information and to investigate all references and educational records. I understand that any false or misleading statements made by me on this application or in conjunction with my physical examination will be sufficient cause for the rejection of this application or for immediate dismissal if such false or misleading information is discovered after my employment. If I am accepted for employment, I agree to abide by the rules and regulations of the employer:



Date:
 
 
How did you hear about us?  
If Newspaper, what publication?  
Other:  
 
 
Please note that all application information will be kept confidential and will not be sold or released.
Please see our Privacy Policy for more information.

In addition, you will receive a copy of your application form via the e-mail address entered above.

Preferred Pharmacy Solutions is an equal opportunity employer.
 
 
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Copyright © 2012 - Preferred Pharmacy Solutions, LLC.
35 Avco Road, Haverhill, MA 01835   I   Telephone: (978) 374-9100   I   Fax: (978) 374-9101
 
 
 
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