Pharmacist/PA Candidate Profile Personal Details Question Title * 1. Please specify which position are you applying for - e.g. Pharmacist Position Nelspruit Question Title * 2. Where did you hear about this position? Pharmacy Connect Email Facebook - PharmacySA group Facebook - Pharmacy Connect's page LinkedIn Word of mouth Pharmacy Connect website Question Title * 3. Personal Details First Name Surname Personal e-mail address Work e-mail address Cell no What city & province do you live in currently? South African Citizen (Yes/No) Racial Group (Black African/White/Coloured/Indian or Asian) English proficiency (Speak/Read/Write) Afrikaans proficiency (Speak/Read/Write) Other language proficiency Willing to travel more than 50km a day (Yes/No) Willing to relocate to another province (Yes/No) Your age Gender Do you have your own transport/vehicle? Question Title * 4. Current Professional Details Employment Status (Permanent/Locum/Unemployed) Availability to Start New Position (dd/mm/yyyy) Question Title * 5. Pharmacy Registration Information Are you a Pharmacist (Yes/No) Are you a Basic PA (Yes/No) Are you a Post Basic PA (Yes/No) Do you have a Grade 12 certificate? (Yes/No) South African Pharmacy Council Registration P Number Registration Status (Active/Inactive/Suspended/Retired) Question Title * 6. Tertiary Education First Qualification (Degree name) Second Qualification (Degree name) Any other courses (e.g. Diploma/Degree) Question Title * 7. PCDT (Primary Care Drug Therapy) Course I have successfully completed the PCDT Course I am busy studying to become a PCDT Pharmacist I would like to study to become a PCDT Pharmacist Other (please specify) Next