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Pharmacist
NAME
LAST 4 OF SSN
PHONE NUMBER
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I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
Proficiency Scale
1 =
No Experience
2 =
Need Training
3 =
Able to perform with supervision
4 =
Able to perform independently
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