Roden-Smith Pharmacy Employment Application

Please provide Contact Information, Availability, Education, Credentials, Work Experience and additional information below. Roden-Smith Pharmacy is an equal employment opportunity employer and as such you are protected from discrimination based on race, color, religion, sex, national origin, disability, age, genetics, from retaliation and all other items enumerated by the law. Some questions found below indicate an option to not answer as " I choose not to disclose ". These items are collected solely for reporting purposes and you do not have to provide an answer to these questions.

Contact Information & Demographics

Full Name?

This is a required question

Address?

This is a required question

City, State ZIP?

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E-mail Address?

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Phone Number?

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Gender?

Male
Female
I Choose Not to Disclose

This is a required question

Race/Ethnicity

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Have you served in the US Armed Forces?

Yes
No
I Choose Not to Disclose

This is a required question

Veteran Status

I AM a Protected Veteran
I am NOT a Protected Veteran
I Choose Not to Disclose

This is a required question

Policy Disclosures

Do you have legal authorization to work in the USA?

This is a required question

Do you agree to be tested for drugs and/or alcohol as permitted by law and may be required of employees per company policy?

This is a required question

Are you willing to submit to a criminal background check?

This is a required question

Are you 21 years of age or older?

This is a required question

If you answered NO to the previous question, please provide your date of birth.

Position and Availability

What type of position are you applying for?

This is a required question

What type of a position are you interested in?

Any Available Position
Full Time (32 hrs or more per week w/ Full Time Benefits)
Part Time (Less than 32 hours per week)
Internship

This is a required question

Are you available to work weekends?

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Are you available to work some holidays?

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When are you available to start work?

Education

Do you speak and understand English?

Yes
No
Other:

This is a required question

Do you speak and understand Spanish?

Yes
No
Other:

This is a required question

Licenses Held

This section may not apply to you and can be left blank if you are not a licensed technician, intern or pharmacist.

Registered Pharmacist License #1 [STATE (i.e. NM), NUMBER, EXPIRATION (mm/dd/yyyy) ? (if applicable)

This is a required question

Registered Pharmacist License #2 [STATE (i.e. NM), NUMBER, EXPIRATION (mm/dd/yyyy) ? (if applicable)

This is a required question

Registered Pharmacist INTERN License [STATE (i.e. NM), NUMBER, EXPIRATION (mm/dd/yyyy) ? (if applicable)

This is a required question

Pharmacy Technician License #1 [STATE (i.e. NM), NUMBER, EXPIRATION (mm/dd/yyyy) ? (if applicable)

This is a required question

Pharmacy Technician License #2 [STATE (i.e. NM), NUMBER, EXPIRATION (mm/dd/yyyy) ? (if applicable)

This is a required question

Certifications Held

Select categories for which you hold additional certifications

Technician Certifications

Certified Pharmacy Technician (CPhT via PTCB)
Compounding (Non-Sterile)
Compounding (Sterile)
Other:

This is a required question

Work Experience

Please list your 3 most recent work experiences. If none, then indicate as such.

Work Experience #1

Please indicate Company Name, City, State, Supervisor Name, Supervisor Phone #, Dates Worked (i.e. mm/yyyy -mm/yyyy), Position Held, Rate of Pay (i.e. $/hr, $/yr salary, etc.), and Reason for Leaving. Also, enter "May Contact" if it is alright for us to contact your previous supervisor.

This is a required question

Work Experience #2

This is a required question

Work Experience #3

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References

Please indicate "Yes" below if during the interview process you would be able to provide contact information for 1-2 References if requested to do so by pharmacy management.

References

YES, If requested I can provide reference information.
NO, If requested I would not be able to provide references.
Other:

This is a required question

Additional Questions

Are you currently, or have you ever been investigated for program-related fraud or patient abuse, licensing board actions, or default on Health Education Assistance Loans?

If Yes, Please Explain in "Other"

Yes
No
Other:

This is a required question

Have you ever been the subject of a pharmacy related license suspension, revocation, or other adverse action by any licensing authority?

If Yes, Please Explain in "Other"

Yes
No
Other:

This is a required question

Have you had any pharmacist, intern or technician license sanctioned?

If Yes, Please Explain in "Other"

Yes
No
Other:

This is a required question

Other

Please provide any other information that you find relevant to your application below.

This is a required question