Get Pharmacist Certification And Authorization Form - New Jersey ... - Newjersey

Completing the Pharmacist Certification And Authorization Form for New Jersey is a vital step in the criminal history background check process. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the form online easily.

1. Use the ‘Get Form’ button to access the certification form and open it in the available editing interface.
2. In the first section, fill out your name. Choose the appropriate prefix (Dr., Mr., Mrs., Ms.) and provide your last, first, and middle name. Include your maiden name if applicable.
3. Next, complete the mailing address section, including your street address or P.O. Box, city, state, and ZIP code. Be sure to use the address that is currently on file with your Board or Committee to avoid delays.
4. Provide your date of birth in the specified format (MM/DD/YYYY) and select your sex by checking the appropriate box.
5. Enter your daytime telephone number, ensuring to include your area code.
6. Fill in your Social Security number, which should consist of all 12 digits.
7. Input your professional license number as required.
8. Indicate whether you have completed the fingerprinting process for any Board or Committee since November 2003 by selecting yes or no. If you select yes, provide the requested details including the Board or Committee name, date of fingerprinting, and professional license number.
9. Disclose if you have ever been arrested or convicted of a crime. If so, you must submit the necessary supporting documents, including police reports or judgments for any convictions.
10. Sign the certification statement at the end of the form, confirming that all information is true and that you authorize the investigation of your background.
11. Finally, review all information for accuracy, save your changes, and take action to download, print, or share the form as needed.

Complete your Pharmacist Certification And Authorization Form online today to ensure a smooth background check process.