Pharmacy Technician

DISCLOUSURE:

Successful completion of the Pharmacy Technician program will qualify a student to apply for a Pharmacy Technician Registration/License with the California State Board of Pharmacy.  The institution will provide a completed, signed and embossed “Affidavit of Completed Coursework or Graduation for Pharmacy Technician” document to be included with the application.  Additionally, the applicant must meet the following requirements and include the required documents with the application to register with the California State Board of Pharmacy:

BASIC EDUCATION:

You must be a high school graduate or have a General Education Degree certificate equivalent.

Attach ONE of the following (A, B, C, or D):

1. S. High School Graduate: Attach an official, embossed transcript (academic record) or notarized copy of your high school transcript. It must have the graduation date on it. To get a copy of your high school transcript, contact your high school or its school district office.
2. Foreign High School Graduate: Attach a notarized copy of your foreign secondary school diploma or certificate OR a notarized copy of your foreign secondary school transcripts. If not in English, then include a certified translation in English. The translation may be from an evaluation service that states your education is equal to graduating high school in the U.S.
3. California High School Equivalency Test (Attached 1, 2, or 3 to show documentation of completing one of the three California High School Equivalency Tests.)
4. General Educational Development (GED): Attach an official transcript of your test results or equivalent. GED test results are official only if they are earned through an authorized GED Testing Center. To get your GED transcripts, go to http://www.gedtestingservice.com/testers/gedrequest-a-transcript. If your GED is from another state, you may need to request an official transcript of your GED test results from the agency in that state.
5. HiSET: Attach an official transcript of your test results or equivalent. HiSET test results are official if they are earned through an authorized HiSET Testing Center. To request your HiSET transcripts, go to diplomasender.com.
6. TASC: Attach an official transcript of your test results or equivalent. TASC test results are official if they are earned through an authorized TASC Testing Center. To request your TASC transcripts, go to http://www.tasctest.com/.
7. Certificate Equivalent – Attach an official “Certificate of Proficiency” showing you passed the California High School Proficiency Examination (CHSPE). To request a copy, go to https://www.chspe.net/cert-trans/ or call (866) 342-4773.

 

PHARMACY TECHNICIAN DOCUMENTS:

Attach ONE of the following (A, B, C, or D):

4. Affidavit of Completed Coursework or Graduation: The program director, school registrar or pharmacist must complete and sign the affidavit on Page 4. Copies or stamped signatures are not accepted. The school seal must be embossed on the affidavit and/or you must attach a pharmacist’s business card with license number. An affidavit is required for one of the following:

• Associate Degree in Pharmacy Technology;
• Any other course that provides a minimum of 240 hours of instruction as required;
• Training course accredited by the American Society of Health-System Pharmacists (ASHP);
• Graduation from a school of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE).

1. Pharmacy Technician Certification Board (PTCB) certified: Submit a copy of your PTCB certificate.
2. National Healthcare Association Pharmacy Technician Certification Program (ExCPT): Submit a copy of your ExCPT certificate. Please check the box on the application on page 1 under the Pharmacy Technician Qualifying Method “Attached is a certified copy of PTCB certificate program”. By checking this box this will identify your application as applying under a certification program.
3. Military Training: Submit a copy of your DD214 documenting evidence of your pharmacy technician training provided by a branch of the federal armed services.

SELF-QUERY REPORT:

Include a sealed, original Self-Query Report from the National Practitioner Data Bank (NPDB). It must be dated within 60 days of filing the application.

• Self-Query Reports that have been opened will not be accepted.
• The name on your Self-Query Report must be EXACTLY THE SAME as the name on your application.
• To request a Self-Query Report, go to the NPDB’s home page at http://www.npdb.hrsa.gov/ or direct page at https://www.npdb.hrsa.gov/ext/selfquery/SQHome.jsp
• NPDB’s contact number (800) 767-6732 or TDD (703) 802-9395. Their website has a fact sheet and answers to frequently asked questions. The board is not able to assist you with requesting the Self-Query Report. For help, contact the NPDB directly.
• You must pay the fee directly to NPDB. The fee is $5.
• You must submit a new Self- Query Report even if one was submitted with a previous application.

FINGERPRINTS:

• California residents must use Live Scan. Non-residents can visit California to complete a Live Scan or must submit professionally rolled fingerprints on cards supplied by the board.
• DO NOT complete the Live Scan service or fingerprint cards until you are ready to send your application.
• You must submit a copy of your Live Scan receipt or new fingerprint cards with your application.
• Each application requires you to complete a new Live Scan or submit new fingerprint cards.
• The Live Scan site may charge a processing fee.
• The board will accept fingerprint responses only from the California Department of Justice (DOJ) and Federal Bureau of Investigation (FBI).

Please complete and attach ONE of the following (A or B):

1. California Resident: Attach completed Live Scan receipt. The receipt shows you completed the Live Scan.

• California residents must use Live Scan only.
• To find a Live Scan location, go to https://oag.ca.gov/fingerprints/locations
• Live Scan operators can make mistakes. You must be sure everything on the form is correct.

Make sure the following information is correct when you complete your Live Scan:

• Type of License/Certification/Permit or Working Title: Pharmacy Tech-Sect 4015
• Full Name: Must be EXACTLY THE SAME as the name on your state driver’s license or state-issued identification card. (Jr., II, etc., must be included). It must also be EXACTLY THE SAME as the name on your application and Self-Query Report.
• Date of Birth: Must be correct.
• Social Security Number: Must be included and be correct, unless you have an ITIN. If you have an ITIN, enter this number in the SSN field.
• Level of Service: Must include both DOJ and FBI.

1. Non-California Resident: You may visit California and complete Live Scan, if you cannot then you must send two rolled fingerprint cards.

• You must use fingerprint cards from the Board of Pharmacy.
• Request fingerprint cards through the board’s online services at https://www.dca.ca.gov/webapps/pharmacy/pubs_request.php or email rxforms@dca.ca.gov.
• Fee: Include fingerprint card processing fee of $49 ($32 DOJ and $17 FBI), made payable to the Board of Pharmacy.
• You can send one check or money order for both the application processing fee and fingerprint processing fee.
• Print legibly or type your personal information on the fingerprint cards. If your personal information is not legible and DOJ enters your information incorrectly, you will be responsible to submit new fingerprint cards and pay the $49 fingerprint processing fee again.
• Fingerprints must be taken by a person professionally trained to roll prints.
• Fingerprint clearances from cards take about six weeks longer than Live Scan.
• Poor quality prints will be rejected and will cause delay because new fingerprint cards will be required.

MILITARY EXPEDITE

The board will expedite review of an application that meets one of the following criteria. Please check the appropriate box and submit this page with your completed application.

SERVING IN THE MILITARY: Are you currently serving in the United States military?

Attach a copy of your military identification.

VETERAN: Have you served in the United States military?

• Attach a copy of your DD214 with your application.

ACTIVE DUTY MILITARY – SPOUSE OR PARTNER: If your spouse or partner is an active duty member of the U.S. Armed Forces and you hold a current license in another state, please provide the following:

Attach a copy of your current license in another state, district, or territory of the

United States documenting the profession or vocation for which you seek license from the board.

Attach a copy of the marriage certificate, or certified declaration/registration of domestic partnership, or other evidence of legal union.

Attach a copy of your spouse or partner’s military orders establishing duty station in California.

Additional Requirements:

You must provide a written explanation for all affirmative answers indicated below. Failure to do so may result in the application being deemed incomplete and being withdrawn.

1. Do you have a mental illness or physical illness that in any way impairs or limits your ability to practice your profession with reasonable skill and safety without exposing others to significant health or safety risks? Yes No

If “yes,” you will need to attach a statement of explanation. If “no,” proceed to #2.

Are the limitations caused by your mental illness or physical illness reduced or improved because you receive ongoing treatment or participate in a monitoring program?          Yes         No

If “yes,” you will need to attach a statement of explanation.

If you do receive ongoing treatment or participate in a monitoring program, the board will make an individualized assessment of the nature, the severity and the duration of the risks associated with an ongoing mental illness or physical illness to determine whether an unrestricted license should be issued, whether conditions should be imposed, or whether you are not eligible for license.

2. Have you previously engaged in the illegal use of controlled substances? Yes No

If “yes,” are you currently participating in a supervised substance abuse program or professional assistance program which monitors you in order to assure that you are not engaging in the illegal use of controlled dangerous substances?       Yes         No

You will need to attach a statement of explanation.

3. Do you currently participate in a substance abuse program or have previously participated in a substance abuse program in the past five years? Yes No

If “yes,” are you currently participating in a supervised substance abuse program or professional assistance program which monitors you to ensure you are maintaining sobriety?      Yes         No

You will need to attach a statement of explanation.

4. Has disciplinary action ever been taken against your designated representative, pharmacist, intern pharmacist and/or pharmacy technician license in this state or any other state? Yes No

If “yes,” you will need to attach a statement of explanation to include circumstances, type of action, date of action and type of license, registration or permit involved.

5. Have you ever had an application for a designated representative, pharmacist, intern pharmacist and/or pharmacy technician license denied in this state or any other state? Yes No

If “yes,” you will need to attach a statement of explanation to include circumstances, type of action, date of action and type of license, registration or permit involved.

6. Have you ever had a pharmacy license, or any professional or vocational license or registration, denied, suspended, revoked, placed on probation or had other disciplinary action taken by this or any other government authority in California or any other state? Yes No

If “yes,” you will need to provide the name of company, type of permit, type of action, year of action and state

7. Are you currently or have you previously been listed as a corporate officer, partner, owner, manager, member, administrator or medical director on a permit to conduct a pharmacy, wholesaler, medical device retailer or any other entity licensed in this state or any other state? Yes No

If “yes,” you will need to provide company name, type of permit, permit number and state where licensed.

8. Have you ever been convicted of, or pleaded guilty or nolo contender/no contest to, any crime, in any state, the United States or its territories, a military court, or any foreign country? Include any felony or misdemeanor offense, and any infraction involving drugs or alcohol with a fine of $500 or more. You must disclose a conviction even if it was: (1) later dismissed or expunged pursuant to Penal Code section 1203.4 et seq., or an equivalent release from penalties and disabilities provision from a non-California jurisdiction, or (2) later dismissed or expunged pursuant to Penal Code section 1210 et seq., or an equivalent post-conviction drug treatment diversion dismissal provision from a non-California jurisdiction. Failure to answer truthfully and completely may result in the denial of your application.

Yes         No

NOTE: You may answer “NO” regarding, and need not disclose, any of the following: (1) criminal matters adjudicated in juvenile court; (2) criminal charges dismissed or expunged pursuant to Penal Code section 1000.4 or an equivalent deferred entry of judgment provision from a non-California jurisdiction; (3) convictions more than two years old on the date you submit your application for violations of California Health and Safety Code section 11357, subdivisions (b), (c), (d), or (e), or California Health and Safety Code section 11360, subdivision (b); and (4) infractions or traffic violations with a fine of less than $500 that do not involve drugs or alcohol.

You may wish to provide the following information in order to assist in the processing of your application: descriptive explanation of the circumstances surrounding the conviction (i.e. dates and location of incident and all circumstances surrounding the incident.) If documents were purged by the arresting agency and/or court, a letter of explanation from these agencies is required.

Failure to disclose a disciplinary action or conviction may result in the license being denied or revoked for falsifying the application. Attach additional sheets if necessary.