Home Services Facility Login About Us Contact Us Employment Employment Employment Be a part of something special From Pharmacists to Technicians, Billing Specialists to Delivery Drivers, we are looking for committed and team orientated employees to help provide the highest level of customer service to our clients within the Long Term Care industry. We foster an environment of accountability, steady growth, and innovative automation technology. It’s because of our thought leading team that we are advancing in the industry. We put the interest of our customers at the heart of our decisions. The work you do will have a direct effect on the communities that we service. At PWP you will make an impact. Join our diverse team of nearly 100 employees who are redefining the LTC industry by fostering meaningful relationships and building loyalty with our clients that lasts. Pacific West Pharmacy Employment Application We are an Equal Opportunity Employer Date Please Print First Name Middle Name Last Name Present Address No. & Street City State Zip Cell Phone Home Phone E-mail Employment Desired Position(s) applying for: Personal Information Have you ever applied to or worked for our Company before? Yes No If yes, when? Do you have any friends or relatives working for our Company? Yes No If yes, state name(s) and relationship: Name Relationship Name Relationship How did you learn about our Company? If hired, would you have a reliable means of transportation to and from work? Yes No Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.) Yes No If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe the functions that cannot be performed. (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.) Education, Training and Experience School Name and Address No. of years Completed Did you Graduate? Degree or Diploma High School Name City State Yes No College/ University Name City State Yes No Vocational/ Business Name City State Yes No Employment History List below all present and past employment starting with your most recent employer (last ten years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume. Dates of Employment Name & Address of Employer Position Title and Responsibilities Supervisor & phone number Reason for leaving From: To: Reason: May we contact this employer? Yes No From: To: Reason: May we contact this employer? Yes No From: To: Reason: May we contact this employer? Yes No Note: Attach additional page(s) if necessary. Please Read Carefully, Initial Each Paragraph and Sign Below Initials I hereby certify that all the information above is true and complete. I have not knowingly withheld any information that might adversely affect my chances for employment. I understand that any falsification, material omission or misstatement of information on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I further certify that I, the undersigned applicant, have personally completed this application. Initials I understand that any offer of employment is conditioned upon complying with all of the Company’s requirements including, but not limited to, signing any requested consent for the Company to conduct an investigation or obtain a report about my background. Initials I hereby authorize Pacific West Pharmacy and its representatives to contact my prior employers and all others for the purpose of verification of all information I have supplied, and to thoroughly investigate my references, work record, education, professional credentials, and other matters related to my suitability for employment. Further, I authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. Initials I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is “at-will” – that is, it is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative. Initials I understand an offer of employment may be made contingent on passing a job-related physical examination if I apply for a delivery driver position or a position with related driving duties in a company vehicle. I agree to submit to a controlled substances screening by the Company’s designated medical practitioner and at the Company’s expense upon receiving a conditional offer of employment from the Company. Initials I understand and agree that in connection with my application for employment or possible assignment to another position within the Company, the Company may solicit and obtain information related to my character, work habits, job performance, experiences and abilities, and the reasons for the termination of past employment. I also understand and agree that internal personnel employed by the Company may request information from various federal, state, and other agencies, including public and private sources that maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background, and other past experiences, to the extent permitted by law. Should the Company obtain public records related to me (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment), I understand that I am entitled to copies of any such public records within seven (7) business days unless I mark the check box below. If the Company takes any adverse action based on the information in such records, including denying me employment, I understand I am entitled to a copy of any such records even though I have checked the box below. I waive receipt of a copy of any public record described in the paragraph above. Date Applicant’s or Employee’s Signature Quick Links Home Page About Us Services Contact Us Facility Login Employment Head Office Address : 4363 Pacific Street Rocklin, CA 95677 Phone : (916) 632-7560 Email : info@pwprx.com Terms & Conditions Site Map Website Design by LOJO Marketing