Official SealSan Joaquin County Human Resources Division


#0624-RH4350-SR
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a Pharmacy Doctorate degree from an accredited university?

Yes No

 

Please ensure this is CLEARLY indicated in the Education section of your application.


2.

Do you have at least two years of professional experience as a pharmacist in an acute care hospital?

Yes No
3.

Did the experience above include clinical responsibilities?

Yes No

 

Please ensure this is CLEARLY demonstrated in the Employment Experience section of your application.

Note: resumes will not be accepted in lieu of a completed application. 


4.

Have you completed an approved one-year clinical or general residency program in pharmacy? 

*This may be substituted for the required experience*

Yes No
5.

Are you currently enrolled in an ASHP-Accredited Pharmacy Residency program and can provide written documentation showing the date that the residency will be completed? (Please note that applicants cannot be appointed until successful completion of the residency program.)

Yes No
6.

Do you possess a valid license as a Registered Pharmacist issued by the California State Board of Pharmacy?

Yes No
 

Pharmacist License Number and Expiration