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Applicant Name

Applicant Last Name

Applicant Address

Applicant City, State, and Zip Code

Email Address

Phone/Mobile

Date of Application

Desired Position (check all that apply)

Processing Operator

Slurry Maker

Wrapper Operator

Packaging Operator

Forklift Operator

Other (please specify)

Desired Shift

Day Shift

Second Shift

Third Shift

Are you available to work Monday – Friday?

Yes

Are you available to work weekends?

Yes

If needed, are you available to work overtime?

Yes

Do you have reliable transportation to our facility?

Yes

Are you currently available to start position?

Yes

What is your desired wage?

Have you ever worked for Pharmaloz Manufacturing, Inc before?

Yes

Do you know anyone that works for Pharmaloz Manufacturing, Inc?

Yes

Are you 18 years of age or older?

Yes

Are you a U.S. Citizen or approved to work in the United States of America?

Yes

Will you consent to a mandatory controlled substance test?

Yes

Do you require any job accommodations?

Yes

What accommodations?

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes

Please state the nature of the crime(s), when, and where convicted and disposition of the case:

Are you able to stand for a 12 hr shift?

Yes

Are you able to lift a minimum of 25 lbs?

Yes

Are you able to read and understand instructions in English?

Yes

Are you able to remove all jewelry for each shift worked?

Yes

Are you able to remain in the building for the entire shift?

Yes

Are you able to operate a forklift or hand jack?

Yes

Are you able to remain focused on the assigned task for extended periods of time?

Yes

Do you have any prior experience working in manufacturing?

Yes

Please list all other skills and/or qualifications that you feel will help you succeed at Pharmaloz Manufacturing:

Job Requirements Checkboxes

Must be able to lift at least 25 lbs repetitively

Must be able to stand for 12 hour shift

Must stay in the building for the entire shift (i.e. no smoking or leaving the building for any reason)

Must be able to remove all jewelry

Must be able to wear hairnets, beard covers, and lab coats in the plant at all times. Nothing can be worn under the hairnets including but not limited to hat, do rags, etc.

No cell phones are allowed on the production floor.

No fake nails are allowed.

Must wear gloves when handling the product.

No eating or drinking other than in the designated lunchroom.

Must wear closed-toe shoes and long pants. Must dress conservative with no rips or holes in the clothing. (NO EXCEPTIONS)

High School

College/University

Vocational/Trade School

List each for the past 5 years

Job Title

Supervisor Name

Employer City, State, and Zip Code

Dates Employed

Employer Name

Employer Address

Employer Telephone

Reason for Leaving

Please provide 3 personal/professional references below

Name & Contact Information

We appreciate your time in completing this questionnaire. The relationship between you and Pharmaloz Manufacturing, Inc. is referred to as “employment at will.” This means that your employment can be terminated for any reason, with or without cause, with or without notice, by you or Pharmaloz Manufacturing, Inc. No representative of Pharmaloz Manufacturing, Inc has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President.

Questions, feedback, or just want to learn more? We are happy to hear from you.

Reach out using the form below and a member of our team will get back to you within one business day.

Contact Information

Pharmaloz Manufacturing, Inc.