Work at The Farmacy The Farmacy > Work at The Farmacy Prefer a paper copy? Stop into the shop and get one from us! The Farmacy - Employment Application Applicant InformationName(Required) First Middle Last Suffix Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email Preferred Name Preferred Pronouns Upload your resume in PDF formatAccepted file types: pdf, docx, doc, txt, Max. file size: 3 MB.Position Applied For Date Available(Required) MM slash DD slash YYYY Days Available Monday Tuesday Wednesday Thursday Friday Saturday Sunday Select AllHours Desired per Week Are you a citizen of the United States?(Required) Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company?(Required) Yes No If so, when? Have you ever been convicted of a felony?(Required) Yes No If yes, please explain EducationHigh SchoolHigh School - Name High School - Address FromToDid you graduate? Yes No Degree CollegeCollege - Name College - Address FromToDid you graduate? Yes No Degree OtherOther - Name Other - Address FromToDid you graduate? Yes No Degree ReferencesPlease list three professional references.Reference #1Name First Last Relationship Company Name PhoneAddress Reference #2Name First Last Relationship Company Name PhoneAddress Reference #3Name First Last Relationship Company Name PhoneAddress Previous EmploymentPrevious Job #1Company Name Supervisor Name Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Previous Job #2Company Name Supervisor Name Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Previous Job #3Company Name Supervisor Name Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Military ServiceBranch From To Rank at Discharge Type of Discharge If other than honorable, please explain Disclaimer and SubmissionCertification(Required) I certify that my answers are true and complete to the best of my knowledgeIf this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
