Official SealDepartment of Human Resources


#CBT-2450-903207
Supplemental Questionnaire

Last Name
First Name

 

2450 Pharmacist

(CBT-2450-903207)

All applicants are required to complete the supplemental questionnaire as part of the online application process. The questionnaire will be used to 1) assess each candidate’s possession of the minimum qualifications; and 2) determine each candidate’s score on the Training and Experience Evaluation, as described on the examination announcement.

Responses to items on the supplemental questionnaire must be supported by the information provided on the application. This information is subject to verification. Please be sure to include all relevant education and experience in the work history and education sections of the application. Resumes are not used or reviewed to determine whether you meet the minimum qualifications or to determine your score/rank. A resume should not be submitted to substitute for a completed application. If you write "see resume" on the application, your application may be rejected.

If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with the information on your employment application and are subject to verification.



 

Part One: LICENSE QUALIFICATIONS

INSTRUCTIONS FOR QUESTION #1: Please answer the question by choosing the best response that matches your background.


1.

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

As a reminder, all licenses must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the "Professional Licenses, Certifications or Registrations" section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update your License before submitting your application.

Yes No

 

 

Part Two: TRAINING AND EXPERIENCE EVALUATION

INSTRUCTIONS FOR QUESTIONS #2a - #6b, and #8a-#9b:

  • Select the response that best matches your education and experience.
  • For the purpose of this Training and Experience Evaluation, please include your post-graduate training experience (as a PGY1 resident, PGY2 resident, and/or post-graduate fellow) toward your professional experience as a Pharmacist for Questions #2a-6b.
  • Responses to the Training and Experience Evaluation questions must be supported by the information in the body of your application (i.e. included in the Education and Training and Employment Record sections) in order to receive appropriate credit, and are subject to verification.

 


2a.

How much verifiable full-time equivalent experience do you have reviewing, processing and dispensing physician medication orders and prescriptions as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
12 or more months (minimum 2,000 hours) of training and/or work experience
2b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable work experience as indicated in Question #2a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type N/A.

Do not type “See Resume.”

3a.

How much verifiable full-time equivalent experience do you have monitoring drug therapy for appropriateness, contraindications, interactions, adverse effects and therapeutic/toxic dosing as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
12 or more months (minimum 2,000 hours) of training and/or work experience
3b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated Question #3a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”

4a.

How much verifiable full-time equivalent experience do you have communicating drug information and/or medication counseling to patients and health care personnel as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
12 or more months (minimum 2,000 hours) of training and/or work experience
4b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated in Question #4a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”

5a.

How much verifiable full-time equivalent experience do you have performing quality assurance by conducting drug use evaluations and medication area inspections as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
12 or more months (minimum 2,000 hours) of training and/or work experience
5b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated in Question #5a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”

6a.

How much verifiable full-time equivalent experience do you have supervising the work of support personnel (Pharmacy Technicians, etc.) as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
12 or more months (minimum 2,000 hours) of training and/or work experience
6b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated in Question #6a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”


 



The following questions will not be scored. They are for informational purposes only.


7a.

What is the highest level of post-graduate training that you have completed?

I do not have any post-graduate training experience.
I am currently enrolled in a PGY1 training program.
I have completed a PGY1 training program.
I am currently enrolled in a PGY2 training program.
I have completed a PGY2 training program.
I am currently enrolled in a fellowship training program.
I have completed a fellowship training program.
7b.

In the text box below, please provide the name of the employer(s) and the dates (e.g. MM/YYYY - MM/YYYY) where you gained the training outlined in Question #7a above.

In addition, please list the name of (a) supervisor(s) or managers(s) who can verifiy the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type "See Resume."

8a.

How much verifiable full-time equivalent experience do you have working with automated dispensing machines (Omnicell/Pyxis/Carousels/high-speed packagers) as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
More than 12 months (minimum 2,000 hours) of training and/or work experience
8b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated in Question #8a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”

9a.

How much verifiable full-time equivalent experience do you have working with IV Admixtures, Total Parenteral Nutrition, and Chemotherapy as a Pharmacist? (Full-time is equivalent to 40 hours per week.)

No training and/or work experience
Less than 12 months (2,000 hours) of training and/or work experience
More than 12 months (minimum 2,000 hours) of training and/or work experience
9b.

Please provide the name of the employer(s) and the dates of employment (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable full-time equivalent professional work experience as indicated in Question #9a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type "N/A" in the box below.

Do not type “See Resume.”

10.

Which of the following settings are you interested in being considered for a Pharmacist position? (check all that apply)

Hospital inpatient pharmacy
Outpatient pharmacy
Outpatient behavioral health pharmacy
Skilled nursing facility pharmacy
County jail facility pharmacy
11.

Please indicate your willingness to work in the following shifts. (check all that apply)

Day Shift
Evening Shift
Night Shift
 

CERTIFICATION: I hereby certify that all information is true and based on my education, training, skills, and experience. I understand that any false or incorrect statement may result in my disqualification of the selection process for this position and/or dismissal from employment with the City and County of San Francisco. I also understand and agree that any information provided is subject to verification.