Application for Employment at Rexco Drug & Gifts
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Email *
Name (First and Last Name) *
Social Security Number *
Address (street number, street name, city, state, and zip code *
Phone Number *
Referred by
List the month, day and year you can begin working. *
MM
/
DD
/
YYYY
What position are you applying for? *
Please list your desired salary. *
Are you employed now? *
If so, may we inquire of your present employer? *
Have you ever applied to work at Rexco Drug and Gifts? *
Have you ever been employed at Rexco Drug and Gifts? *
If yes, when did previous employment with Rexco end?
If previously employed at Rexco Drug and Gifts, what was the reason for leaving?
Please list the name of your high school. *
Please list the city and state where your high school is located. *
Did you graduate from high school or obtain a GED? *
Please list the name and location the college you attended. (college name, city and state)
Please list the name and location the college you attended. (college name, city and state)
Please list the name and location the college you attended. (college name, city and state)
Did you graduate from college? *
Please list the name(s) and location(s) of trade, business, or correspondence school you attended.
Did you earn a degree or certificate of completion? *
Please list any special areas of training that would make you a good fit for this position. *
Please list any special skills that would make you a good fit for this position. *
1. Please list your most recent employer (business name). *
1. Please list your most recent employer's location (City and State). *
1. Please list a contact person for your most recent employer. *
1. Salary *
1. Position *
1. Reason for leaving? *
2. Please list your next most recent employer (business name). *
2. Please list your most recent employer's location (City and State). *
2. Please list a contact person for your most recent employer. *
2. Salary *
2. Position *
2. Reason for leaving? *
3.  Please list your next most recent employer (business name). *
3.  Please list your most recent employer's location (City and State). *
3. Please list a contact person for your most recent employer. *
3. Salary *
3. Position *
3. Reason for leaving? *
1. Reference: Please list the full name of a reference who is not related to you. *
1. Phone Number *
1. Number of Years he/she has known you. *
2. Reference: Please list the full name of a reference who is not related to you. *
2. Phone Number *
2. Number of Years he/she has known you. *
3. Reference: Please list the full name of a reference who is not related to you. *
3. Phone Number *
3. Number of Years he/she has known you. *
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act {ADA} and other relevant federal and state laws. I understand that a customer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment." In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.  TYPE YOUR NAME AND DATE BELOW AS YOUR SIGNATURE IF YOU AGREE TO THE ABOVE. *
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