Volunteer Application

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Become a volunteer and help support the daily operations of the SVDP Community Pharmacy.
- Licensed Pharmacist
- Financial/Eligibility Screener -Training provided so you can work with potential clients to determine their program eligibility
- Pharmacy Technician - Fill perscriptions and, if able, input data entry on Pharmacy Computer. Training provided by Pharmacist in charge.
- Administrative Support
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number (Home) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Phone Number (Cell) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Have you ever volunteered at SVDP Pharmacy before? REQUIRED Yes No Please fill out this field.
- If applicable, please list all relatives volunteering at SVDP Pharmacy: Please enter valid data.
- If applicable, please list all names used in the past (e.g., maiden): Please enter valid data.
- Please list highest level of education (e.g., Masters in Nursing from Univ. of USA): REQUIRED Please fill out this field. Please enter valid data.
- Describe any special training, certifications, or skills: REQUIRED Please fill out this field.
- Languange(s): REQUIRED English Spanish Other Please fill out this field.
- Employment History: List all present and past employment beginning with most recent:
  Dates (from/to) - Employer Address/Phone - Position/Role - Supervisor - Reason for Separation
- Please provide at least two (2) references who are familiar with your ability and background (e.g., John Smith 228-555-5555): REQUIRED Please fill out this field.
- CONSENT
  
  I give permission to St. Vincent de Paul Community Pharmacy to contact my references about my record and character.
  I Agree Please select this field.
- Have you been convicted of a felony? REQUIRED No Yes Please fill out this field.
- If yes, please explain: Please enter valid data.
- CONSENT
  
  I give permission to St. Vincent de Paul Community Pharmacy to conduct a post-placement credit/criminal background check.
  I Agree Please select this field.
Submit

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