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#1123-RH4331-AC
Supplemental Questionnaire

Last Name
First Name
 

All information within the employment application will be reviewed to help assess your qualifications.  Please be sure to complete your Employment Experience section of the application and provide a description of your PRIMARY duties.  Resumes will not be accepted in lieu of an application. 

By checking this box, you are acknowledging the statement above.
 

Do you have a valid license as a Registered Pharmacist issued by the California State Board of Pharmacy?
Yes No
 

Do you have a Master's degree in Pharmacy or a Doctor of Pharmacy degree from an accredited college or university?
Yes No
 

Have you completed an ASHP-accredited Pharmacy Practice Residency?
Yes No