STAFF APPLICATION FORM - (Permanent Placements)
Company Details
Name of Pharmacy
Name of Proprietor/Manager
Address of Pharmacy
NZPE PCS number	If unknown please leave blank
Business phone
Fax
Residential phone	(important as we work evenings)
Mobile phone
Other
Email
Position Available
Pharmacist	AssistantManagerOther
Technician	GeneralMedical Pack Dispenser
Pharmacy Assistant	OTCCosmeticRetail ManagerOther
Comments
ADVERTISING INSTRUCTION: Advertisement Reads or is Enclosed
Link-Line
Internet
Other (please specify)
WHAT EXPERIENCE IS REQUIRED TO FILL THIS POSITION (please list)
Total Management, Dispensary Management, etc.
What computer system ?
How many scripts per day/week ?
Do you have a Dual Checking System ?
Do you have 'Point of Sale' ?
Photo Mini Lab ?
Cosmetic Houses ?
Natural Health Products ?
Other
CONFIDENTIAL BUSINESS
Your Pharmacy
Do you have a technician ?
How many staff/staff backup ?
Where will this person fit in (what area/skills required)?
Approximate size of Pharmacy ?
Main Street or Mall ?
Is it more Dispensary, Cosmetic Orientated, or a 7 Day Urgent ?
Some idea of: Wages & Conditions of Employment (We can discuss wages or rates of pay if requested) ?
Employment Times
Days/hours
Saturday
Sunday
Late nights
Your clients - are they ?
Suburban
Young family
Elderly/retired
City/professional
Rural
What does your city/town have to offer ?
Schooling (from pre-school to college/uni)
Housing(availability of houses/flats to buy or rent)
Sport Facilities (Clubs and Recreation)
Outdoor Activities and Scenic Attractions
Comments
Any other comments to help us find the right person for you. Any special offers, incentives or package deals, which makes your position more attractive? Any particular concerns you may have, due to past experience.
I agree that any relevant information supplied by me may be disclosed to prospective employees.