Work with us.

Pharmacy, gift store, photo center, framing and SnoBiz — one store, a lot of ways to fit in.

Job application

We hire in person. Fill the application out right here and print it, or download the blank PDF to fill out by hand - then bring your completed, signed application into the store. We don't accept applications by email or online.

When you drop off your application, ask for Jane.

Download blank application (PDF)

205 N E St
Oskaloosa, IA 52577

(641) 673-3439

Nothing you type below is saved or sent anywhere — it stays on this device until you print it. When you’re done, print it, sign it, and bring it into the store.

APPLICATION FOR EMPLOYMENT

Pre-Employment Questionnaire • Equal Opportunity Employer

Personal Information...

DATE:

Name (last name first):

Social Security No:

Present address:

Permanent address:

Phone:

Second phone:

State:

Zip code:

State

Zip code:

Referred by:

Employment Desired...

Position:	Date you can start:	Salary desired:
Are you currently in employment? YES NO	If so, can we inquire of your present employer? YES NO	Are you legally able to work in the U.S.? YES NO
Have you ever contacted this company before? YES NO	When:	Where:

Education History...

	Name and location of school	Years attended	Did you graduate	Subjects studied
High school
College
Trade, business, or correspondence school

Additional Information...

Subject of special study / research work:

Special training:

Special skills:

U.S. military or naval service:

Rank:

Previous Employers... (LIST YOUR LAST FOUR EMPLOYERS, WITH THE LATEST ONE AT THE TOP)

Date month / year	Name and address of employer	Salary	Position	Reason for leaving
FROM:TO:
FROM:TO:
FROM:TO:
FROM:TO:

References... (LIST THREE PERSONS NOT RELATED TO YOU, WHOM YOU'VE KNOWN FOR OVER A YEAR)

Name	Address	Business	Years known

Authorization

“I certify that the facts contained in this application form are true and complete to the best of my knowledge and that I understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize an investigation of all statements contained in this application, and employers and references listed above to give you any and all information requested regarding my previous employment and any other pertinent information they may have, personal or otherwise, and release the company from all liability for the damage that may result from the use of this information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

Signature: Date:

Interviewed by: Date:

DO NOT WRITE BELOW THIS LINE

Remarks

Character

Neatness:	Character:
Personality:	Ability:

Hired:

For dept:

Position:

Will report:

Salary:

APPROVED:

EMPLOYMENT MANAGER

DEPARTMENT HEAD

GENERAL MANAGER

This application for employment is for general use. Mahaska Drug is an Equal Opportunity Employer. It is the user's responsibility to ensure that this form's use complies with applicable local, state, and federal laws, which change from time to time.