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MedsPLUS Pharmacy Pathways Application Form
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MedsPLUS Pharmacy Pathways Application Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
may here City,
Name
*
First
Last
Date of Birth
*
dd/mm/yyyy
Home Address
*
City, State, ZIP Code
*
Phone Number
*
Email Address
Preferred Contact Method
*
Phone
Email
Text
Eligibility Requirements
*
I am at least 18 years old
I have earned a high school diploma or GED
I understand that a background check will be conducted as part of this program
I acknowledge that I have no disqualifying criminal history that would prevent me from obtaining an Alabama pharmacy technician license
I understand that successful program completion requires participation in a PTCB-recognized training course
To qualify for this program, check each box to confirm your eligibility
Have you ever been convicted of a felony or misdemeanor related to drugs, theft, or fraud?
Yes (If yes, please explain below)
No
You may write explanation here if needed
High School/GED Program Name
City & State
Year Graduated
Most Recent Employment (if any)
Employer / Position / Dates of Employment (mm/yyyy - mm/yyyy) / Reason For Leaving
Personal Reference (1)
Full Name / Relationship / Phone Number / Email
Personal Reference (2)
Full Name / Relationship / Phone Number / Email
Program Commitment & Consent
*
I understand that successful completion of this program does not guarantee employment, but job placement assistance will be provided.
I acknowledge that I must complete all training, assessments, and licensing
I consent to a background check as required by the Alabama Board of Pharmacy.
I certify that all information provided is true and accurate to the best of my knowledge.
Please read and acknowledge the following
Communication Preferences
*
By checking this box, I consent to receive conversational, marketing, and customer care SMS from MedsPLUS Pharmacy & Wellness Center. Reply STOP to opt-out; Reply HELP for support; Message & data rates may apply; Messaging frequency may vary. Visit
Privacy Policy
to see our privacy policy and
Terms
for our Terms of Service.
By providing your phone number, you consent to receive text messages (including automated messages) from MedsPLUS regarding your account, services, and updates relevant to you. For full details on how we collect, use, and protect your information, please review our Terms and Conditions and Privacy Policy found below the submit button.
Submit
