Application

Red asterisk* fields are mandatory and application will not submit if left blank.
Applicant’s legal name:
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Primary Contact Number

Emergency Contact:

Support Contact

Please use the best contact that will be available to reach during class time.

About You

Please complete the information below. Information is imperative to complete a CVS application.

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Transportation:

History:

Have you ever been fired or asked to leave a job or worksite? If yes, please explain: *
Have you quit a job or worksite? If yes, please explain: *
Have you ever applied to CVS? *
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Please be prepared to provide us with your CVS log-in information during the first week of class. (This is very important as CVS has strict guidelines when you can reapply and retake the virtual tryout).
In the past six months, have you submitted applications to any other business? *

Adaptations/accommodation you may need to work or assist you in the classroom:

List three references:

If possible, one of your three references should include a professional reference. This is someone who can give insight about your character, work ethic, reliability, etc. Examples of possible professional references are: a previous employer, supervisor, colleague, co-worker, volunteer organization, teacher, mentor, church.







Education:

Please list the last certificate or diploma you completed.

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BCI Requirement

CVS requires that all students placed in externships have a current (within the past 60 days) BCI background check. All participants in the AccessPoint RI/CVS Workforce Development Program are required to have the BCI accomplished before the first day of class. Students must bring the BCI background check with them on their first day of class.

Information on obtaining BCI background checks can be found on the Attorney General’s Website:  www.riag.gov

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