Official SealSan Joaquin County Human Resources Division


#1022-TH9218-TM
Supplemental Questionnaire

Last Name
First Name
1.

Are you currently enrolled in an accredited college of pharmacy?
Yes No
 

If Yes, please provide the name of the college of pharmacy which you are attending:
2.

Do you currently have valid registration as an Intern Pharmacist issued by the California State Board of Pharmacy?
Yes No
 

If Yes, please provide your Intern Pharmacist registration number and expiration date:

 

If you do not have current registration as an Intern Pharmacist, you must be able to obtain a valid certificate of registration as an Intern Pharmacist issued by the California State Board of Pharmacy within six (6) months of employment.