Bi Mart Employment Application Form PDF Details

Looking for a job in Oregon? Bi Mart is always hiring! You can find their employment application form on their website. The application is straightforward and easy to fill out. Be sure to include your resume and any other relevant information. Bi Mart will review your application and contact you if they are interested in scheduling an interview. Good luck!

QuestionAnswer
Form NameBi Mart Employment Application Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesFIRSTAPPLICANTS, firefox bi mart, WASHINGTON, bi mart application

Form Preview Example

APPLICATION FOR EMPLOYMENT

Dear Applicant:

We are pleased that you are interested in employment at Bi-Mart! To be considered for possible employment, applications must be accompanied by a signed and dated summary of the position for which you are applying. Please review the position summary thoroughly before completing this application. This Application for Employment will be considered “active” for one (1) month from the date signed.

Bi-Mart is strongly committed to providing a safe and productive work environment for its employees and to providing excellent service to its customers. As a part of the hiring process, all applicants considered for employment are required to submit to and pass a drug test.

I N ST RU CT I ON S

PLEASE ANSWER ALL QUESTIONS TO THE BEST OF YOUR ABILITY.

PRINT LEGIBLY WITH AN INK PEN (OR YOU MAY TYPE THE ANSWERS IF YOU ARE COMPLETING AN ONLINE APPLICATION).

DO NOT LEAVE BLANK SPACES—PRINT N/A (NOT APPLICABLE) WHEN NECESSARY.

AREA OF I N T EREST & AV AI LABI LI T Y

POSITION SOUGHT: ____________________________________________________________________________________________________________________________________

 

FULL TIME q

PART-TIME q

TEMPORARY/SEASONAL

q

 

 

 

 

 

Have you previously applied for employment at Bi-Mart? YES q

NO q

 

 

 

 

 

When? _______________________________ For what position? _______________________________ What location? _______________________________

PAY EXPECTED:

$ _____________________________ If “Negotiable”, enter range: _____________________________ Date you can start: _____________________________

 

WE OPERATE 7-DAYS PER WEEK. PLEASE INDICATE WHAT HOURS YOU CAN WORK. WRITE “ANY” IF YOU ARE AVAILABLE ALL HOURS.

AVAILABLE HOURS: MON: ____________ TUE: ____________ WED: ____________

THU: ____________

FRI: ____________

SAT: ____________ SUN: ____________

REFERRED BY:

NEWSPAPER AD: _______________________________ SCHOOL: _______________________________ INTERNET: _______________________________

(CHECK ONE)

 

 

(Specify)

(Specify)

 

 

 

(Specify)

 

STORE ANNOUNCEMENT: q

COMPANY RECRUITER: q

OTHER q

(Explain): _______________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

PERSON AL I N FORM AT I ON

 

 

 

 

 

FULL NAME:

____________________________________________________________________________________________ SS#: _________________________________

 

(LAST)

 

 

(FIRST)

 

(FULL MIDDLE)

 

 

 

ALL OTHER

 

 

 

 

 

 

 

 

 

LAST NAMES USED: _______________________________________________________________ NICKNAME(S): _____________________________________________________

CONTACT

 

 

 

 

 

 

 

 

 

INFORMATION:

HOME PHONE #: __________________________________________ WORK PHONE #: _________________________________________________________

 

CELL PHONE #: ___________________________________________ E-MAIL ADDRESS: ________________________________________________________

CURRENT

 

 

 

 

 

 

HOW

 

 

MAILING ADDRESS:

_____________________________________________________________________________________________ LONG?

_____________________________

 

(NO. & STREET)

 

 

(CITY)

(STATE)

(ZIP CODE)

 

 

(IF LESS THAN 3 YRS. PLEASE

 

 

 

 

 

 

 

 

 

PROVIDE PREVIOUS ADDRESS)

CURRENT

 

 

 

 

 

 

 

 

 

STREET ADDRESS:

_____________________________________________________________________________________________

 

 

 

 

(NO. & STREET)

 

 

(CITY)

(STATE)

(ZIP CODE)

 

 

 

PREVIOUS

 

 

 

 

 

 

HOW

 

 

STREET ADDRESS:

_____________________________________________________________________________________________ LONG?

_____________________________

 

(NO. & STREET)

 

 

(CITY)

(STATE)

(ZIP CODE)

 

 

 

AGE INFORMATION:

ARE YOU 18 OR OLDER? YES: q

NO: q IF HIRED, CAN YOU PROVIDE PROOF OF YOUR AGE? YES: q

NO: q

DRIVER’S LICENSE

 

 

 

 

 

 

 

 

 

OR STATE ISSUED ID: YES: q

NO: q

STATE: ________ NUMBER: _________________________________________ EXP. DATE: ______________________

 

 

 

 

 

 

 

 

 

(MM/DD/YYYY)

CITIZENSHIP:

CAN YOU PROVIDE PROOF OF YOUR LEGAL RIGHT TO REMAIN AND WORK IN THE U.S.A.? YES: q

NO: q

 

PREVIOUSLY

YES: q

NO: q

IF YES, WHAT LOCATION/DEPT.: ______________________________________________________________________________

EMPLOYED

 

 

 

NAME OF

 

DATES

 

 

BY BI -MART?:

JOB TITLE: _______________________________ SUPERVISOR: _______________________________ EMPLOYED: _______________________________

RELATIVE/FRIENDS

YES: q

NO: q

IF YES, NAME: ____________________________________________ RELATIONSHIP: _______________________________

CURRENTLY EMPLOYED

 

 

 

 

 

 

 

 

BY BI -MART?:

LOCATION/DEPARTMENT: ___________________________________________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

Revision: 8/09

PAGE 1 OF 5

EDU CAT I ON

SCHOOLS ATTENDED

 

 

CIRCLE HIGHEST

 

WHAT NAME(S) ARE

DIPLOMA OR GED

 

 

GRADE COMPLETED

 

RECORDS UNDER?

YES (ü)

NO (ü)

 

 

 

 

LAST JR. HIGH/MIDDLE SCHOOL:

 

1

2

3

4

5

6

7

8

 

 

 

 

 

 

 

 

(City)

(State)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST HIGH SCHOOL:

 

 

 

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

(State)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLEGE/UNIVERSITY OR TECHNICAL/TRADE OR MILITARY SCHOOLS ATTENDED:

 

WHAT NAME(S) ARE

 

DEGREE OR

MAJOR(S)

(Include City and State)

 

 

RECORDS UNDER?

 

CREDITS RECEIVED

 

 

 

 

 

NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

(State)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

(State)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIST ANY CURRENT LICENSES/CERTIFICATES/REGISTRATIONS: ______________________________________________________________________________________________

Are you currently attending school? NO q

YES q Hours / Days attending: _____________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

WORK EX PERI EN CE

LIST YOUR MOST RECENT JOB FIRST—APPLICANTS MUST PROVIDE A COMPLETE RECORD OF ALL EMPLOYMENT IN THE LAST 15 YEARS. INCLUDE MILITARY SERVICE.

AND INDICATE DATES AND REASONS FOR PERIODS OF UNEMPLOYMENT IN EXCESS OF THIRTY (30) DAYS. USE ADDITIONAL SHEETS IF NEEDED .

#

1

 

 

 

 

 

 

 

DATE EMPLOYED

 

 

COMPANY/ORGANIZATION

JOB TITLE/DUTIES PERFORMED

JOB TITLE/DUTIES PERFORMED

 

 

 

 

 

 

 

 

(Month & Year)

 

 

(Complete Name & Address)

AT START OF EMPLOYMENT

AT END OF EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

______________________________________

 

 

 

 

MO

YR

MO

YR (Name)

 

 

 

 

 

(FROM)

(TO)

 

 

 

 

 

 

 

TYPE OF BUSINESS?

______________________________________

 

 

 

 

 

 

(Street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________________________

 

 

 

 

 

 

 

 

 

(City)

 

(State)

(Zip)

 

 

 

 

 

HOW WAS POSITION

AVG. HRS.

 

SALARY

NUMBER OF

REASON FOR LEAVING OR LOOKING

 

 

 

 

WORKED

AT

UPON

PEOPLE YOU

IMMEDIATE SUPERVISOR

 

 

 

OBTAINED?

 

TO LEAVE (BE SPECIFIC)

 

 

 

 

PER WEEK

START

LEAVING

SUPERVISED

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: _______________________________________

 

 

 

 

 

 

 

 

 

 

TITLE: _______________________________________

 

 

 

 

 

 

 

 

 

 

PHONE #: ____________________________________

 

 

 

 

 

 

 

 

 

 

MAY WE CONTACT NOW?

YES q

NO q

# 2

DATE EMPLOYED

 

COMPANY/ORGANIZATION

 

JOB TITLE/DUTIES PERFORMED

JOB TITLE/DUTIES PERFORMED

 

 

 

 

(Month & Year)

 

(Complete Name & Address)

 

AT START OF EMPLOYMENT

AT END OF EMPLOYMENT

 

 

 

 

/

 

______________________________________

 

 

 

 

MO

 

YR

MO

YR

(Name)

 

 

 

 

 

 

 

 

(FROM)

 

(TO)

 

 

 

 

 

 

 

 

 

TYPE OF BUSINESS?

 

______________________________________

 

 

 

 

 

(Street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________________________

 

 

 

 

 

 

 

 

 

(City)

 

(State)

(Zip)

 

 

 

 

 

HOW WAS POSITION

AVG. HRS.

 

SALARY

NUMBER OF

REASON FOR LEAVING OR LOOKING

 

 

 

 

WORKED

AT

UPON

PEOPLE YOU

IMMEDIATE SUPERVISOR

 

 

 

OBTAINED?

 

TO LEAVE (BE SPECIFIC)

 

 

 

 

PER WEEK

START

LEAVING

SUPERVISED

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: _______________________________________

 

 

 

 

 

 

 

 

 

 

TITLE: _______________________________________

 

 

 

 

 

 

 

 

 

 

PHONE #: _____________________________________

 

 

 

 

 

 

 

 

 

 

MAY WE CONTACT NOW?

YES q

NO q

PAGE 2 OF 5

WORK EX PERI EN CE CON T I N U ED

#

3

 

 

 

 

 

 

 

DATE EMPLOYED

 

 

COMPANY/ORGANIZATION

JOB TITLE/DUTIES PERFORMED

JOB TITLE/DUTIES PERFORMED

 

 

 

 

 

 

 

 

(Month & Year)

 

 

(Complete Name & Address)

AT START OF EMPLOYMENT

AT END OF EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

______________________________________

 

 

 

 

MO

YR

MO

YR (Name)

 

 

 

 

 

(FROM)

(TO)

 

 

 

 

 

 

 

TYPE OF BUSINESS?

______________________________________

 

 

 

 

 

 

(Street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________________________

 

 

 

 

 

 

 

 

 

(City)

 

(State)

(Zip)

 

 

 

 

 

HOW WAS POSITION

AVG. HRS.

 

SALARY

NUMBER OF

REASON FOR LEAVING OR LOOKING

 

 

 

 

WORKED

AT

UPON

PEOPLE YOU

IMMEDIATE SUPERVISOR

 

 

 

OBTAINED?

 

TO LEAVE (BE SPECIFIC)

 

 

 

 

PER WEEK

START

LEAVING

SUPERVISED

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: _______________________________________

 

 

 

 

 

 

 

 

 

 

TITLE: _______________________________________

 

 

 

 

 

 

 

 

 

 

PHONE #: ____________________________________

 

 

 

 

 

 

 

 

 

 

MAY WE CONTACT NOW?

YES q

NO q

# 4

DATE EMPLOYED

 

COMPANY/ORGANIZATION

 

JOB TITLE/DUTIES PERFORMED

JOB TITLE/DUTIES PERFORMED

 

 

 

 

(Month & Year)

 

(Complete Name & Address)

 

AT START OF EMPLOYMENT

AT END OF EMPLOYMENT

 

 

 

 

/

 

______________________________________

 

 

 

 

MO

 

YR

MO

YR

(Name)

 

 

 

 

 

 

 

 

(FROM)

 

(TO)

 

 

 

 

 

 

 

 

 

TYPE OF BUSINESS?

 

______________________________________

 

 

 

 

 

(Street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________________________

 

 

 

 

 

 

 

 

 

(City)

 

(State)

(Zip)

 

 

 

 

 

HOW WAS POSITION

AVG. HRS.

 

SALARY

NUMBER OF

REASON FOR LEAVING OR LOOKING

 

 

 

 

WORKED

AT

UPON

PEOPLE YOU

IMMEDIATE SUPERVISOR

 

 

 

OBTAINED?

 

TO LEAVE (BE SPECIFIC)

 

 

 

 

PER WEEK

START

LEAVING

SUPERVISED

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: _______________________________________

 

 

 

 

 

 

 

 

 

 

TITLE: _______________________________________

 

 

 

 

 

 

 

 

 

 

PHONE #: ____________________________________

 

 

 

 

 

 

 

 

 

 

MAY WE CONTACT NOW?

YES q

NO q

# 5

DATE EMPLOYED

 

COMPANY/ORGANIZATION

 

JOB TITLE/DUTIES PERFORMED

JOB TITLE/DUTIES PERFORMED

 

 

 

 

(Month & Year)

 

(Complete Name & Address)

 

AT START OF EMPLOYMENT

AT END OF EMPLOYMENT

 

 

 

 

/

 

______________________________________

 

 

 

 

MO

 

YR

MO

YR

(Name)

 

 

 

 

 

 

 

 

(FROM)

 

(TO)

 

 

 

 

 

 

 

 

 

TYPE OF BUSINESS?

 

______________________________________

 

 

 

 

 

(Street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______________________________________

 

 

 

 

 

 

 

 

 

(City)

 

(State)

(Zip)

 

 

 

 

 

HOW WAS POSITION

AVG. HRS.

 

SALARY

NUMBER OF

REASON FOR LEAVING OR LOOKING

 

 

 

 

WORKED

AT

UPON

PEOPLE YOU

IMMEDIATE SUPERVISOR

 

 

 

OBTAINED?

 

TO LEAVE (BE SPECIFIC)

 

 

 

 

PER WEEK

START

LEAVING

SUPERVISED

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME: _______________________________________

 

 

 

 

 

 

 

 

 

 

TITLE: _______________________________________

 

 

 

 

 

 

 

 

 

 

PHONE #: ____________________________________

 

 

 

 

 

 

 

 

 

 

MAY WE CONTACT NOW?

YES q

NO q

- U SE ADDI T I ON AL SH EET S I F N EEDED -

PAGE 3 OF 5

ABI LI T I ES

After reviewing the position summary for the job(s) for which you are applying, do you believe that you can perform all of the functions listed? YES q NO q

If no to the above, please identify any functions of the job which you are unable to perform and describe how you might be able to perform the job with reasonable accommodation(s):

______________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________

 

 

BACK GROU N D

 

 

TERMINATION:

Have you ever been discharged or asked to resign from a job?

YES q

NO q If yes, please explain:__________________________________________________________________________________________________________

*CONVICTIONS:

Have you ever been convicted by a criminal or military court of a felony or misdemeanor, including criminal traffic and criminal non-traffic offenses?

YES q

NO q If yes, please explain: ______________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________

*In most cases, a conviction is not an automatic bar from employment.

SK I LLS AN D I N T EREST S

DO NOT include the names of clubs, organizations, associations, etc., which indicate the race, creed, religion, age, national origin, political views or any other protected class of it’s members. List outside activities while in school (athletics, clubs, offices held):

Related hobbies/interests:

List technical/occupational skills (include level of proficiency):

Personal aptitudes/interests:

Career aims/goals:

COM M EN T S

MAKE ANY ADDITIONAL COMMENTS YOU WISH IN THE SPACE BELOW:

PAGE 4 OF 5

ACCEPT AN CE

It is the policy of Bi-Mart to recruit, employ, transfer, develop and promote individuals without regard to race, national origin, ancestry, religion, age, sex, gender identity, marital status, disability, or any other protected class as provided by law.

1.I declare that all statements and answers herein are true and complete, and understand that any untruth, misleading answer, omission, concealment, or failure to answer questions fully, completely, and accurately are grounds for termination of my employment.

2.I authorize Bi-Mart at any time to investigate my references, to communicate with former employers concerning same, and to make an independent investigation of my character, conduct, employment, criminal, financial, and driver’s records.

3.I agree that Bi-Mart, my previous employers and any other sources used in this investigation shall not be held liable in any respect if an employment offer is not tendered, is withdrawn, or my employment is terminated due to false statements or answers in this application or any other information gained in this investigation.

4.I agree to return all company records, equipment, and uniforms upon termination of employment.

5.I understand that this application for employment is not a contract of employment. All employment at Bi-Mart is strictly “Employment At Will” which means that an employee may voluntarily end his/her employment at any time with or without notice for any reason, and the company maintains the same right. This relationship cannot be modified by anyone other than in writing by the Senior Vice President of Human Resources or the President of the Company. Any representations by any other person contrary to the “Employment At Will” Doctrine, either verbal or written, shall not be relied upon by any employee.

_________________________________________________________________________________________________________

(SIGNATURE OF APPLICANT)

DATE

BUSINESS OFFICE AND DISTRIBUTION CENTER

220 S. SENECA RD. P.O. BOX 2310 EUGENE, OREGON 97402

PHONE 541/344-0681 FAX 800/333-8967

PAGE 5 OF 5

CERTIFIED PHARMACY TECHNICIAN

Position Overview

Assist in the accurate and timely prescription filling process, (as permitted by law) data entry, inventory, stocking, and maintaining merchandise. Build, promote and deliver a high degree of customer satisfaction.

Reports To: Pharmacy Manager, or person in charge

Coordinates With: Pharmacy Manager, staff pharmacists, pharmacy staff, store management, receiving personnel, Bookkeeper, Regional Pharmacy Manager, Vice President of Pharmacy Operations, and administrative staff.

Essential Job Functions

Accurately process and label prescriptions as designated by prescriber in a professional manner and in compliance with local, state, and federal regulations. This function is performed under the direct supervision of a licensed pharmacist.

Ensure that the accuracy of prescription contents and labeling is checked and initialed by a licensed pharmacist.

Identify system flags to alert a pharmacist of drug interactions.

Receive written prescriptions and/or refill orders from customers.

Request and receive authorizations or prescription refill via telephone.

Inform customers when prescriptions are ready.

Accurately maintain all files pertaining to the pharmacy (prescription file, controlled substance file, etc.).

Accurately and completely collect and enter into the computer all customer demographic and prescription information, including third party insurance information.

Keep merchandise priced, clean, neat, and supplies well-stocked.

Count, electronically order, and check in merchandise and supplies.

Work as a team with management, pharmacy manager, pharmacists, area coordinators, and coworkers.

Operate a terminal/register as customer flow dictates or as assigned. Accurately read prices, scan merchandise, receive payment, and give correct change.

Ensure every customer is satisfied by answering all questions politely and quickly, escorting customers to the requested items or calling for customer assistance.

Bi-Mart Corporation

October, 2003

Physical Requirements

Occasionally = up to 1/3 shift

Frequently = up to 2/3 shift

Continuously = throughout shift

Standing: Continuously in combination with walking on hard surface.

Sitting: 0% of the time.

Walking: Continuously in combination with standing.

Worker Mobility: Can change positions frequently throughout work shift.

Carry/Lift: Independently work with 0-45 pounds depending on product and materials being stocked.

Pushing/Pulling: Occasionally push/pull merchandise on hand trucks or stocking carts. Continuously and independently push/pull single case lots or items while stocking or moving merchandise.

Bending/Squatting: Frequently throughout the work shift while operating cash register/bagging merchandise, stocking supplies, and cleaning.

Reaching/Handling: Use of fingers/hands/arms continuously. Frequent overhead reaching needed for higher shelf stocking and retrieving.

Grasping/Squeezing: Frequently throughout work shift.

Twisting: Frequently throughout work shift.

Climbing: Occasionally climb ladders to reach higher shelf areas. Occasionally climb stairs.

Crawling: 0% of the time.

Social Skill Requirements

Ability to positively interact with others.

Ability to effectively send and receive verbal communication.

Ability to respond sensitively to patient/customer needs and/or situations.

Aptitude Requirements

Must be able to read English and write it legibly.

Must be able to perform advanced math functions.

Must have ability to analyze, reason, and use good judgment.

Must be able to learn and retain and new skills.

Bi-Mart Corporation

October, 2003

Certification/Licensing Requirements

WASHINGTON

Must be certified and licensed in the state of Washington.

Must successfully complete the Washington approved Bi-Mart Pharmacy Technician Training Program and pass the Bi-Mart PDX Competency Exam.

Must complete, under the supervision of a state registered preceptor, 120 hours of Preceptor Training.

Completion of 4 hours of AIDS Education.

OREGON

Must be state registered.

Must complete the Bi-Mart Pharmacy Assistant and Technician Training Programs and the Bi-Mart PDX Competency Exam.

Environmental Factors

Most work is performed in store.

Some exposure to outside elements.

Possible exposure to chemicals and/or compounds throughout work shift.

This position summary covers most of the duties performed, however, other duties and responsibilities not listed may be assigned at the discretion of management.

After reviewing this position summary, can you perform all of the functions listed?

Yes

No

If no to the above, please identify any functions that you are unable to perform:

I verify that I have thoroughly reviewed the position summary for Certified Pharmacy Technician and that I understand the job requirements and essential job functions.

Signature: ___________________________________________________ Date: _______________________

Print Name: __________________________________________________

Bi-Mart Corporation

October, 2003

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