Job Application

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

(EEO and Privacy Statement)

It has been and will continue to be the policy of Brookshire Brothers/Polk Oil Company to be an equal opportunity employer. Our objective is to recruit, hire, train, and promote into all job levels the most qualified applicants without regard to race, color, religion, sex, national origin, age, disability, or veteran’s status. Any information you provide below will be treated as personal and confidential. It will not be shared to other parties nor will it be used for any other purpose other than evaluation of your qualifications for employment.

_{This Application Will Be Considered Active For One Year.}

Position being applied for:

Pharmacy Clerk

Date:

04/16/2024

Stores:

Onalaska, TX 77360 -- 14658 U.S. Hwy. 190 W. -- Brookshire Brothers -- Store #71

Personal Information

First Name:

Middle Initials:

Last Name:

Last 4 Digits of Social Security #:

XXX - XX -

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Telephone (ex. 555-123-4567):

Alternate Telephone:

_{(You must add no-reply@brookshirebrothers.com to your address book to make sure you receive the email, especially if you have a spam filter)}

Email Address:

Are you under 18 years of age?

Yes

Do you have any relatives currently employed with Brookshire Brothers/Polk?

Yes

If yes, please list their names:

Have you ever been employed with us before?

Yes

If yes, give place/date and reason(s) for leaving:

Hours Available to Work

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
A.M.
P.M.

Employment History

(List in order -- beginning with current or most recent employer)

Present or Last Employer
Employer Name: Dates Employed: to Address: City, State: Supervisor: Rate of Pay: Reason for Leaving: Job Title and Summary of Duties:

Previous Employer
Employer Name: Dates Employed: to Address: City, State: Supervisor: Rate of Pay: Reason for Leaving: Job Title and Summary of Duties:

Educational Background

(List in order -- beginning with current or most recently attended)

Name and Location of School	Major / Minor	Degree / GED

(Optional) Attach a resume or cover letter in WORD, TEXT or PDF format only:

Sun	Mon	Tue	Wed	Thu	Fri	Sat