MedsPLUS Pharmacy Pathways Application

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* Name

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* Date of Birth (dd/mm/yyyy)

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* Home Address

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* City, State, Zip Code

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* Phone Number

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* Email Address

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* Preferred Contact Method

Phone

Text

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* Eligibility Requirements

I am at least 18 years old

I have earned a high school diploma or GED

I understand that a background check will be conducted as part of this program

I acknowledge that I no disqualifying criminal history that would prevent me from obtaining an Alabama pharmacy technician license

I understand that successful program completion requires participation in a PTCB- recognized training course

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* Have you ever been convicted of a felony or misdemeanor related to drugs, theft, or fraud?

Yes (If yes, please explain below)

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* You may write explanation here if needed

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* High School/GED Program Name

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* City and State

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* Year Graduated

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* Most Recent Employment (if any)- Include employer, position, dates of employment (mm/yyyy-mm/yyyy), and reason for leaving.

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* Personal Reference (1)- Include full name, relationship, phone number, and email

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* Personal Reference (2)- Include full name, relationship, phone number, and email

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* Program Commitment & Consent

I understand that successful completion of this program does not guarantee employment, but job placement assistance will be provided.

I acknowledge that I must complete all training, assessments, and licensing

I consent to a background check as required by the Alabama Board of Pharmacy.

I certify that all information provided is true and accurate to the best of my knowledge.

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* Please upload an updated resume

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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