Job Application - Tims Pharmacy & Gift Shop

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Name *

First

Middle

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you legally authorized to work in the United States? (Note: Proof of eligibility will be required upon hire.) *

Are you at least 18 years of age? (Note: Certain pharmacy roles may require a minimum age due to handling controlled substances.) *

What position are you applying for? *

Pharmacist
Pharmacy Technician
Pharmacy Assistant
Pharmacy Intern
Other (Please Specify)

Other (Please Specify) *

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Educational Background

What degrees or certifications have you obtained, including the institution name and field of study?

Degree/Certification *

Institution *

Field *

Degree/Certification

Institution

Field

Degree/Certification

Institution

Field

Licenses

Do you hold any professional licenses (e.g., pharmacy technician license)? If yes, please list the license type, number, and issuing state.

License Type *

Number *

State *

License Type

Number

State

License Type

Number

State

Current License Status:

Are all listed professional licenses current and in good standing with the issuing authority? If not, please explain.

Current License Status *

Yes
No (Please Explain)

No (Please Explain) *

Additional Training:

Have you completed any training programs relevant to pharmacy operations (e.g., compounding, customer service)? If yes, please describe.

Additional Training *

Yes (Please explain)
No

Yes (Please Explain) *

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Upload Resume

Click or drag a file to this area to upload.

Previous Employment

Please list your previous employers, job titles, dates of employment, and primary responsibilities, starting with the most recent.

Employer *

Job Title *

Start Date *

End Date *

Still Employed 1

I'm still employed here

Resonsibilities *

Employer

Job Title

Start Date

End Date

Still Employed 2

I'm still employed here

Resonsibilities

Employer

Job Title

Start Date

End Date

Still Employed 3

I'm still employed here

Resonsibilities

Please explain your Pharmacy-Specific experience. *

Put N/A if you do not have pharmacy experience.

Language Skills

What languages do you read, write, or speak fluently? (Note: This is relevant for assisting diverse customers in a pharmacy.)

1st Language

1st Read, Write, Speak

Read
Write
Speak

2nd Language

2nd Read, Write, Speak (copy)

Read
Write
Speak

No additional Languages

No additional Languages

Technical Skills:

Do you have experience using pharmacy management software (e.g., Epic, QS/1) or point-of-sale systems? If yes, please specify. *

Put N/A if you do not have any experience.

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Essential Functions

Can 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?

Essential Functions *

Yes
No (Please Explain)

Please Explain *

Customer Service Skills:

Do you have experience handling customer inquiries or resolving conflicts in a professional setting? If yes, please provide an example.

Customer Service Skills *

Yes
No (Please Explain)

Please Explain *

Availability

What is your availability for work, including days, hours, and shifts (e.g., evenings, weekends)?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Desired Compensation:

What is your desired compensation for this position?

Salary Amount *

Salary Duration *

Hourly
Annualy

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References

Please provide the names, titles, and contact information of three professional references who can speak to your work experience and qualifications.

First & Last Name *

Title *

Phone *

First & Last Name *

Title *

Phone *

First & Last Name *

Title *

Phone *

At-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?

At-Will Employment Acknowledgment: *

Background Check Consent:

If 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.)

Background Check *

specify. Statement: Name

Nondiscrimination Statement:

Centralia 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.

Nondiscrimination Statement: *

I understand

Accuracy Certification:

I 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.

Signature *

Clear Signature

Date / Time *

Educational Background

Licenses

Current License Status:

Additional Training:

Previous Employment

Language Skills

Technical Skills:

Essential Functions

Customer Service Skills:

Availability

Desired Compensation:

References

At-Will Employment Acknowledgment:

Background Check Consent:

Nondiscrimination Statement:

Accuracy Certification:

We’re hiring Staff Pharmacists!