PHMIC Logo
Pharmacists Mutual Pharmacists Life Pro Advantage Services
Skip navigation links
Home
Solutions For
Product Lines
Insurance By State
Services
About Us
Careers
Contact Us
Online Services
Skip Navigation LinksPharmacists Mutual Companies > Pharmacists Mutual Insurance Home > Job Application

Applicant Information
Step 1 of 6 * indicates a required field

First Name *

MI

Last Name *

Preferred Name (if different)

Address *

City *

State *

 

Zip Code *

Primary Phone Number *

(including area code with no dashes or spaces)


 

Primary Phone Number Ext.

Alternate Phone Number

(including area code with no dashes or spaces)


Alternate Phone Number Ext.

Email Address *


 

Confirm Email Address *



 

Contact Preference *


Who referred you or what prompted you to apply for work here?

Position for which you are applying *


 

Expected Salary or Wage

Age *



Are you legally eligible for employment in the United States? *

___________________________________________


Have you ever been convicted of a felony or crime involving fraud or a dishonest act?   Conviction of a crime is not an automatic bar to employment.   *


If yes, please explain.

___________________________________________


Note: This section needs to be completed by sales representative applicants.

Do you have a valid driver's license?

Has your license ever been suspended/revoked?

Please list all traffic violations in the past 5 years


I agree to give my permission for Pharmacists Mutual to obtain personal motor vehicle reports pertaining to my driving record. Any misrepresentation, when discovered, will result in termination.
___________________________________________