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First Name*

Last Name*

Email*

Phone*

Are you a registered Pharmacy Tech in Washington or Oregon state?*

No

Yes

What is your Pharmacy Tech license number and State?*

Do you have BLS certification? *

No

Yes

What specialties do you float to?*

Do you have the COVID Vaccination?*

No - Requesting Exemption

Yes - Vaccinated

Yes - Vaccinated with Booster

Typically for strike assignments: 5x12/hr shifts (60/hrs week) Are you ok with this?*

No

Yes

Can you work a Day shift?*

No

Yes

Can you work a Mid shift?*

No

Yes

Can you work a Night shift?*

No

Yes

What is your Primary Shift preference?*

Day

Mid

Night

100% Flexible

How many years experience do you have as a Pharmacy Tech?*

Have you worked as a Pharmacy Tech in the past year?*

No

Yes

At what facility have you worked as a Pharmacy Tech most recently?*

How much experience do you have in a hospital setting?*

What type of clinic settings have you worked, if any?

Do you have inpatient experience or outpatient experience, or both?*

Inpatient

Outpatient

Both

What medication dispensing equipment or brands do you have experience with?

Do you have IV experience?*

No

Yes

Do you have Oncology experience?*

No

Yes

Describe your Pharmacy Tech experience:*

Please supply an Emergency Contact name and phone number:*

NW - Potential Strike

Submit Request