Employment - tru|med dispensary

NAME: Last, First, Middle *

Street Address, City, State, Zip *

Email Address *

Phone Number *

Social Security Number *

Driver's License Number *

Employment Desired *

Full TimePart TimeFull or Part Time

Are you able to perform the essential functions of the job you are applying for, with or without reasonable accomodation? *

YesNo

Are there days of the week or times during the year that you are not available to work? *

YesNo

If you answered yes to the above please explain.

Date Available to Start *

Level of School Completed *

High School or GEDSome CollegeCollege Degree

If none apply list highest grade completed.

College or Business School(most recent first) Please include years of attendance, major, and indicate graduation, currently attending, or not completed.

List Occupational Licenses, certificates, or registrations including relevant license numbers, location issued, and expiration date.

Military Service *

YesNo

Branch Served In

Date of Entry

Date of Discharge

Honorable Discharge

YesNo

Special Skills

Have you ever been convicted of a felony? *

YesNo

Experience with Medical Marijuana *

Experience with medical marijuana is not necessary. However, any experience as a patient, caregiver, or cultivator is welcome. Please indicate whether you have experience.YesNo

Patient ID#

Care Giver ID#

Experience/Knowledge of Medical Marijuana

Previous Experience: List Previous employment starting with most recent. Include company name, address, phone number, position, and dates employed. *

I have read and understood the following information:

I certify the information in this application is true, correct, and complete. I understand that, if employed, false statements reported on this application may be considered sufficient cause for dismissal. If hired, you will be an employee At-Will. By your signature you consent to the employer conducting an background check and drug screening. AZ Compassionate Care, Inc. will conduct a criminal background check and drug test on all prospective employees. In addition, the Arizona Department of Health Services requires all employees to submit fingerprints to the department for a criminal background check. AZ Compassionate Care, Inc. uses the E-Verify employment verification system. Note: Medical use of Marijuana detected in a drug test will not exclude an applicant from employment as long as the applicant has a valid medical marijuana patient identification card.I have read and understood the information listed herein.

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