Employment Application

Wiley’s Pharmacy is an Equal Opportunity Employer. We offer both Part Time and Full Time positions at our four locations throughout Lancaster County. Jobs at Wiley’s include a benefits package with: Health, Dental and Eye Care, as well as Paid Vacations and Holidays. Please fill out our employment application below to apply to Wiley’s Pharmacy today.

Select Preferred Location

Millersville

Quarryville

Hempfield

Strasburg

Position Desired

How Did You Learn About Us?

Personal Information

First Name*

Middle Initial

Last Name*

Address*

City*

State*

Select A State

Zip*

County*

Township / Borough*

Phone Number*

Email Address*

If you are you under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Have you ever filled out an application with us before?

Yes

Have you ever been employed with us before?

Yes

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
Proof of citizenship or immigration status will be required upon employment.

Yes

On what date would you be available for work?*

What are you available to work?

Full Time

Part Time

Temporary

Is there anything that would prevent you from working evenings & weekends?

Yes

Are you currently on “lay-off” status and subject to recall?

Yes

Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment.

Yes

Education

High School
(Please state Name and Location of School, # of Years Attended, Subjects Studied and if you received a Diploma/Degree)

Undergraduate College / University
(Please state Name and Location of School, # of Years Attended, Subjects Studied and if you received a Diploma/Degree)

Graduate / Professional
(Please state Name and Location of School, # of Years Attended, Subjects Studied and if you received a Diploma/Degree)

Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any honors you have received:

State any additional information you feel may be helpful to us in considering your application:

List professional, trade, business, or civic activities and offices held
(You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or other protected areas)

References

Give name, address and telephone number of three references who are not related to you and are not previous employers.

Have you ever had any job-related training in the United States military?

Yes

Have you been counseled or disciplined for attendance problems on prior jobs?

Yes

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteers activities. You may exclude organizations which indicate race, color, religion, gender, national origin, or other protected status.

Employer #1
(Please indicate date started, date ended, name and address of employer, your salary, your position/work performed and your reason for leaving)

Employer #2
(Please indicate date started, date ended, name and address of employer, your salary, your position/work performed and your reason for leaving)

Employer #3
(Please indicate date started, date ended, name and address of employer, your salary, your position/work performed and your reason for leaving)

Employer #4
(Please indicate date started, date ended, name and address of employer, your salary, your position/work performed and your reason for leaving)

Special skills and qualifications
(Summarize special job-related skills and qualifications acquired from employment or other experience.)

Names of relatives employed by us

Employment Experience

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should reapply.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such a change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by the rules and regulations of the employer.

We are an Equal Opportunity Employer.

Date of application

*Required fields