(636) 441-1414 info@greenrxinc.com

    Application for Employment at GreenRX

    Equal Opportunity

    GreenRX is an equal opportunity employer and pledges itself to the following policy for all employees as well as applicants for employment. GreenRX will hire, place, upgrade, transfer, promote, recruit, advertise, solicit for employment, pay and otherwise compensate, select for training, layoff or terminate without regard to race, color, creed religion, political views, sex, age, national origin, ancestry, marital status, disability, or handicap in accordance with applicable federal, state and local law.

     

    Personal Information:

    First Name (Required):
    Middle Name :
    Last Name (Required):
    Your Email (Required):
    Do you have a legal right to live and work in the United States?: YesNo
    APPLICANT MAY BE SUBJECT TO VERIFICATION OF LEGAL RIGHT TO LIVE AND WORK IN THIS COUNTRY.

     

    Home Phone Number:
    Cell Phone Number:
    Referred By?:

     

    Present Address

    Address, City, State and Zipcode. (Required)

    Permanent Address

    Address, City, State and Zipcode.

     

    Employment Desired

    Position you are applying for? (Required):
    Date You Can Start (Required):
    Salary Desired (Required):
    Are you employed?: YesNo
    If so, may we inquire of your present employer?: YesNo
    Have you ever applied to this company before?: YesNo
    Where did you apply for this company before?:
    When did you apply for this company before?:

     

    Educational History:

    List name and location of school, years attended, did you graduate, subjects studied.
    Grammar School (Required):
    High School (Required):
    College:
    Trade or Business School:

    Employment History:

    List your employment history, beginning with your most recent job.

    Present or Most Recent Employer

    Employer #1 (Required):
    Supervisor (Required):
    Your Title (Required):
    Employer's Address (Required):
    Employer's Phone (Required):
    Starting and Ending Salary:
    Dates of employment (Required):
    Reason for leaving (Required):

     

    Employer 2

    Employer #2:
    Supervisor:
    Your Title:
    Employer's Address:
    Employer's Phone:
    Starting and Ending Salary:
    Dates of employment:
    Reason for leaving:

     

    Employer 3

    Employer #3:
    Supervisor:
    Your Title:
    Employer's Address:
    Employer's Phone:
    Starting and Ending Salary:
    Dates of employment:
    Reason for leaving:

     

    Additional Comments

    Additional Comments:

     

    By submitting this form 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 the references 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 forgoing, 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.