	Human Capital Management

	#190516-X25A-01
	Supplemental Questionnaire


Last Name	First Name

Do you have any of the following?

six (6) months of experience as a pharmacy clerk or work involving the maintenance of inventory records

fifteen (15) semester hours of college coursework

a combination of experience as a pharmacy clerk or work involving the maintenance of inventory records AND college coursework that totals six (6) months

none of the above

STOP! You have completed the required screening questions for this Job Family. Please verify you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire. The questions below will be used for scoring in lieu of a written exam.

What experience do you have assisting a pharmacist in filling prescriptions and counting pills?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A in the box.

What experience do you have receiving and completing invoices for pharmaceutical and medical supplies that are requisitioned?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

Please check any of the following computer experience you have.

I have experience using Microsoft Word or similar word processing software.

I have experience using Microsoft Excel or similar spreadsheet software.

I have experience entering alpha-numeric data.

I have no experience with any of the above.

What experience do you have dispensing filled and labeled prescriptions?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

What experience do you have managing pharmaceuticals and medical supplies according to expiration dates?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

What experience do you have maintaining inventory and processing outdated stock?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

What experience do you have ordering pharmaceuticals and medical supplies?

I have performed this task independently as a regular part of my job.

I have performed this task as a regular part of my job with some supervision.

I have had classes or training on this task but have not yet performed it on the job.

I have no experience with this task.

How many years of experience do you have as a pharmacy clerk?

I have never been employed as a pharmacy clerk.

Less than one year

1-3 years

4-5 years

more than 5 years

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.