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4132 E. 51st St. | Tulsa, OK 74135

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NextGenRx Job Application

Name: NextGenRx Compounding Pharmacy
Price range: $

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Oklahoma Resident?

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Name*

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Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Position Desired:*

Pharmacist

Pharmacy Tech

Customer Service

Delivery Driver

Please Add License Number:

I Am Seeking:*

Full-Time

Part-Time

Either

Desired Salary/Hourly Rate:*

Highest Level of Education:*

Degree Obtained:

Where Did You Attend High School?

Year Graduated:

Where Did You Attend College?

Year Graduated:

List Certifications:

Are you verified to work in United States?*

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No

Do you have a valid driver's license?*

Yes

No

Can you stand for prolonged periods of time?*

Yes

No

Do you have a reliable means of transportation?*

Yes

No

I am available to work:*

Now, I am not currently employed

After sufficient notice is given to my current employer

Employment is contingent upon passing pre-employment drug test. Do you agree to submit to drug screening?*

Yes

No

My personal goals are: (please list three)*

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