Shop Online Weekly Ad In Store Pharmacy Employment Contact Us Application for Employment An Equal Opportunity Employer Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. All information given will be available only to persons who have a "need to know" or as required by law. This company will make reasonable accomodation in the application process, if needed. * indicates required field Personal Information First Name* Last Name* Middle Name Street Address* City* State* Zip* Primary Phone Number* Secondary Phone Number Email Address Work Preference Date Available:* Salary or Pay You Expect* List job benefits, other than wages, you expect or want in order of importance: Describe your prior experience in the kind of work you want: Describe any job related formal schooling or training: List any job related licenses or certificates you may have: List any job related special skills you may have (typing, machine operation, etc.): Note: Please indicate conditions you prefer or would accept and other information by entering "yes" or "no" in every blank in the remainder of the sections on this page. Availability For Work Work preference:* Full-time Part-time Temporary or Short Term Long-term Shift preference:* Day Afternoon Night Shift Rotating Will you work daily overtime on occasion if necessary?* Yes No Will you work extra days in the week if necessary?* Yes No Present Employment Do you have to give advance notice to your present employer?* Yes No Personal Would you be willing to consent to a background check or reasonable suspicion drug testing?* (Not applicable where prohibited by law) Yes No Have you missed more than a day or two of work or school for any reason in the past five years?* Yes No x Are you a minor (under 18 years old)?* Yes No Prior Events Have you ever worked for or applied for work at this company before?* Yes No Have you ever been discharged for cause?* Yes No Have you ever been convicted of a criminal offense?* Yes No x If yes, please explain (A conviction will not necessarily disqualify an applicant.): Education and Training Grade and High School Name of Last School*: Location*: Did you graduate?* Yes No Grade Point Average*: Special Courses (typing, etc.)*: Select the highest grade you completed in high school/secondary school:* 6th 7th 8th 9th 10th 11th 12th College/University College/Univ. Name: College Location: College Years Attended: College Major Subject: Degree attained in college/university: Grade Point Average: Other (Graduate, Trade School, Correspondence School, etc) Name of School: Location of School: Length of Course: Major Subject: Was course completed?* Yes No Grade Point Average: Record of Employment Current/Most Recent Employer Name of Employer* Address* City* State* Phone Number* Start Date* Are you still employed with this company?* Yes No If No, Employment End Date Starting Rate of Pay?* Ending Rate of Pay?* Reason for Leaving* Supervisor's Name* Supervisor's Title* List the jobs you held, duties performed, skills used or learned, advancements or promotions* May we contact this employer for a reference? Yes No Add Employer Certificate of Applicant Read carefully before signing All information provided by me is true and correct to the best of my knowledge. I understand any omissions or misrepresentations on this application may result in rejection or if employed, may be cause for subsequent dismissal. I hereby authorize any former employer, person, firm or corporation listed herein including this company to answer any and all question and agree to hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me. I understand and agree that any employment I may obtain is for no definite period of time. If employed, I agree to comply with all rules of the company as a condition of continued employment. This Employment Application is used to notify me that the nature and scope of an investigation, if one is conducted, could include such general identification information as residence verification, and, as applicable, information concerning my employment, education, general reputation, character, personal characteristics, and habits, and that such information may be developed through personal interviews with third parties such as family members, neighbors, friends, associates, former employers, financial sources, and custodians of official records. Only job-related information developed from such a report will be considered in evaluating my employment application or continued employment. I hereby authorize these persons, companies, organizations or corporations to answer all questions or release any information regarding the items listed in this paragraph. I hereby release them from any liability and hold them harmless from any claim for releasing any truthful information within their knowledge and/or records. I authorize the company to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information concerning my work experience with the company. I hereby release and hold the company harmless from any claim for releasing any truthful information within its knowledge and/or records. Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, disability, sex, etc. "An equal opportunity employer". Digital Acknowledgement Name:* Date:* Submit Application This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Stay in touch via your inbox Sign up to receive emails with our weekly ad, information about special events and offers. Subscribe Store Information Phone Number (435) 738-2394 Fax Number (435) 738-2430 Pharmacy Phone Number (435) 738-3784 Address 171 East Main Duchesne, UT 84021 Store Hours Mon-Sat: 7 AM to 9 PM Sunday: Closed Pharmacy Hours Mon-Fri: 8:30 AM to 6 PM Saturday: 12 PM to 2 PM Sunday: Closed Our Services Online Shopping Copyright 2021. Design and Maintenance by Associated Food Stores. Administration Contact us Career opportunities Recalls