Pierce Pharmacy Management

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Job Application

PPM Job Application

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*Drug Test Required*
Legal Name*
First Last
Position applied for:*
- Pharmacist
- Lead Certified Pharmacy Technician
- Certified Pharmacy Technician
- Pharmacy Technician
- Pharmacy Technician Trainee
- Patient Advocate
- Delivery Driver
- Merchandising Specialist
- Store Manager
- Customer Service Associate
- Marketing & Public Relations Assistant
- Floral
- Floral Delivery
Location applied for:*
- Pierce Pharmacy Management
- Best Drugs of Trenton
- Mobility Warehouse
- Moye's Pharmacy
- Pharm House Drug
- PHD Cleveland, TN
- Southcare Pharmacy
- Wender & Roberts Pharmacy
- Martha Mae's Floral & Gifts
- Buddy's
Which Moye's Pharmacy location(s)?*
- Downtown McDonough
- Hampton
- Locust Grove
- Stockbridge
- Jackson
Which Pharm House Drug location(s)?*
- La Grange
- Sonora
- Trinity
Which Buddy's location(s)?*
- Jackson
- Covington
Which Wender & Roberts Pharmacy location(s)?
- Buckhead/West Paces
Date available for employment:
Desired Salary:*
Personal Data
Street Address*
City and State*
Zip Code*
Email*
Home Phone
Work Phone
Cell Phone*
Other name(s) under which you have been employed:
How did you hear of this opening?
- Advertisement
- Social Media
- Walk-in
- Other
Will you accept (check all that apply):*
- Full-time
- Part-time
Availability: List days and hours available.*
Are you 18 years of age or older?*
- Yes
- No (If no, proof of eligibility to work will be required.)
Are you eligible to work in the United States either because you are a U.S. Citizen or have U. S. government permission to do so?*
- Yes
- No
NOTE: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States.
Have you ever filed an application with us before?
- Yes
- No
If so, when?
Have you ever been employed with us before?
- Yes
- No
If so, when and where?
Give name, relationship & department of any relatives/friends who are or have been employed with the Company the past 5 years.
DRIVER’S HISTORY INFORMATION
Do you have a valid Driver’s License?*
- Yes
- No
License #
Class
If other then Georgia, state issued

Work Experience
Describe your work history beginning with your current or most recent job. Include military and volunteer experience and periods of unemployment. Failure to give complete information regarding each job held may result in your disqualification. Complete addresses with zip codes and telephone numbers for all employers are necessary.
1. Name of Organization or Firm:*
Phone*
Address*
City and State*
Zip Code*
Dates Employed: From month/year*
To month/ year*
Total Time Employed*
Pay Start*
End*
Official Job Title*
Supervisor*
Describe Your Specific Job Duties*
Specific Reason for Leaving*
2. Name of Organization or Firm:
Phone
Address
City and State
Zip Code
Dates Employed: From month/year
To month/ year
Total Time Employed
Pay Start
End
Official Job Title
Supervisor
Describe Your Specific Job Duties
Specific Reason for Leaving
3. Name of Organization or Firm:
Phone
Address
City and State
Zip Code
Dates Employed: From month/year
To month/ year
Total Time Employed
Pay Start
End
Official Job Title
Supervisor
Describe Your Specific Job Duties
Specific Reason for Leaving
4. Name of Organization or Firm:
Phone
Address
City and State
Zip Code
Dates Employed: From month/year
To month/ year
Total Time Employed
Pay Start
End
Official Job Title
Supervisor
Describe Your Specific Job Duties
Specific Reason for Leaving
Are you currently employed?
- Yes
- No
May we contact your present employer?
- Yes
- No
Describe any additional training, skills or extra-curricular activities:
Computer Skills: WPM?
Computer Skills:
- Spreadsheet
- Word Processing
Additional skills:
List machinery and equipment, certifications or other qualifications that relate to the type of work for which you are applying:
Are you able to perform all duties listed in the job description?*
- Yes
- No
If no, please explain what can be done to provide you with reasonable accommodation?

Authorization to Release Information & Conditions of Employment
I have made application for employment with Pierce Phamacy Management and its affiliated companies. I authorize any persons or organizations to give the company any and all information concerning my previous employment, education or any other information, personal or otherwise, with regard to any of the subjects covered by this application. I release all parties from liability for any damage whatsoever for issuing same. Furthermore, I acknowledge that if I become employed by the company, my employment will be at-will and may be terminated with or without cause at any time by me or by the employer. If required, for the position which I am applying, I consent to undergo a physical examination and/or psychological examination after I have received a conditional offer of employment, as deemed necessary. Before any applicant can be employed with the company they must successfully pass all required examinations. You must select yes to “Authorization to Release Information & Conditions of Employment”, even though we may not contact your present employer.*
- Yes
- No
Applicant’s Certification & Agreement
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that the falsification of this application or the omission of complete information will result in disqualification, or upon discovery, termination of employment. The company is hereby authorized to make any investigation of my prior educational and work history. Finally, I agree that all records submitted (i.e: resumes, letters of reference) or generated for purposes of employment are property of and shall remain the property of the compnay. The information provided on the application is subject to public disclosure under the Georgia Open Records Act.*
- Yes
- No
Alcohol & Controlled Substance Testing
As a condition of employment with the company, you will be required to submit to an alcohol and controlled substance test. Employees must, as a condition of employment, abide by the company’s policies regarding the effects of drug use and the unlawful possession of controlled substances. Employees are expected to report for work without the effects of illegal drugs and alcohol in their bodily systems. Employees must report any conviction under a criminal drug statute for such violations. In order to be employed by the company, you must successfully pass the aforementioned testing and will be required to undergo random drug testing for the duration of employment. By selecting yes, I acknowledge the above and consent to such an examination and test.*
- Yes
- No
Fleet Vehicle Policy Agreement
If applying for a position that requires use of company vehicles, you must have and maintain a valid driver's license in your state of employment, as well as a clean motor vehicle report. Any changes to the status of your license, including any tickets or citations incurred, must be reported to your direct supervisor immediately. By selecting yes, I acknowledge the above requirements of the position I have applied for.*
- Yes
- No
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Name
First Last
Section Break
Untitled
- First Choice
- Second Choice
- Third Choice
Website
Email
This field is for validation purposes and should be left unchanged.

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