We’re Hiring Step 1 of 6 16% Your Personal InformationPlease complete all fields accurately. Qualified applicants are considered for all positions without regard to protected characteristics. You may also email your resume to travis@heddensrx.com to supplement your application.Your Name(Required) First Middile Initial Last Your Email Address(Required) Enter Email Confirm Email Your Phone(Required)Physical Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are you legally authorized to work in the United States?(Required)Proof of eligibility will be required upon hire.YesNoAre you at least 18 years of age?Certain pharmacy roles may require a minimum age due to handling controlled substances.YesNoWhat position are you applying for? Pharmacist Pharmacy Technician Pharmacy Assistant Pharmacy Intern Other (please specify below) If you selected "other" above please specify. Educational BackgroundWhat degrees or certifications have you obtained? Please include the institution name and field of study. Degree / CertificationInstitutionFieldDegree / CertificationInstitutionFieldDegree / CertificationInstitutionFieldLicensesDo you hold any professional licenses (e.g., pharmacy technician license)? If yes, please list the license type, number, and issuing state.License TypeLicense NumberStateLicense TypeLicense NumberStateLicense TypeLicense NumberStateNo License I currently hold no licensesAre all listed professional licenses current and in good standing with the issuing authority?If not, please explain. Yes No If you selected "no" above, please explain here:Have you completed any training programs relevant to pharmacy operations?For example, compounding, customer service? If yes, please describe. Work ExperiencePlease list your previous employers, job titles, dates of employment, and primary responsibilities, starting with the most recent.Business NameJob TitleStart Date Month Day Year End DateLeave blank if still employed. Month Day Year ResponsibilitiesSecond EmployementBusiness NameJob TitleStart Date Month Day Year End DateLeave blank if still employed. Month Day Year ResponsibilitiesThird EmployementBusiness NameJob TitleStart Date Month Day Year End Date Month Day Year ResponsibilitiesDo you have experience in a pharmacy setting?For example, dispensing medications, inventory management, customer service? If yes, please describe. If not, please type “no pharmacy experience”.What languages do you read, write, or speak fluently?Please list each language and list whether you read, write, and/or speak the language. This is relevant for assisting diverse customers in a pharmacy.Do you have experience using pharmacy management software?For example, Epic, QS/1 or point-of-sale systems? If yes, please specify. If not, please write none. Job RequirementsCan you perform the essential functions of the position for which you are applying, such as standing for extended periods, lifting up to 25 pounds, or accurately dispensing medications, with or without reasonable accommodation? Yes No If you selected "no" above, please explain.Do you have experience handling customer inquiries or resolving conflicts in a professional setting?If yes, please provide an example. If no, please write “no experience”.AvailabilityWhat is your availability for work, including days, hours, and shifts (e.g., evenings, weekends)? MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhat is your desired compensation for this position?Amount – hourly rate or annual salary ReferencesPlease provide the names, titles, and contact information of three professional references who can speak to your work experience and qualifications. Name of First ReferenceTitlePhone/Email Number of First ReferenceName of Second ReferenceTitlePhone/Email Numberof Second ReferenceName of Third ReferenceTitlePhone/Email Number of Third ReferenceEmergency Contact(Required)TitlePhone/Email Number of Emergency Contact(Required) Additional NoticesAt-Will Employment Acknowledgment:Do you understand that employment with Centralia Pharmacy is at-will, meaning either party may terminate the employment relationship at any time, except as prohibited by law? I understandBackground Check ConsentIf offered a position, do you consent to a background check, including verification of licenses and, where job-relevant, criminal history? (Note: A criminal record will not automatically disqualify you unless directly related to the job’s requirements, per Washington State law.) I understandCertification and Signature Accuracy CertificationI certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading information may result in disqualification or termination if hired. Today's Date Month Day Year Nondiscrimination StatementCentralia Pharmacy Group is an equal opportunity employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, veteran status, or the presence of a non-job-related medical condition or disability. Employment with Centralia Pharmacy is at-will, meaning either party may terminate the employment relationship at any time, except as prohibited by law. 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