Medallion Rx Staffing: Pharmacist Application

Thank you for your interest in MedallionRx Staffing.

Please fill out the following form to inquire about our services:

(Note: all fields are required.)

Permanent or Temporary Assignments?

First Name:

Last Name:

E-mail Address:

Address:

City: State: Zip Code:

Daytime Phone: (e.g. xxx-xxx-xxxx) Extension:

Evening Phone: (e.g. xxx-xxx-xxxx) Extension:

Mobile Phone: (e.g. xxx-xxx-xxxx)

Best time to reach you:

Pharmacist License Numbers

State:

State:

State:

Areas of Experience:

Hospital	Oncology	Nuclear
Long-Term Care / Consulting	Clinical	Management
Long Term Care / Staff	IV	Compounding
Retail	Pharmacokinetic Consulting	Other
Other:

Please upload your resume or copy and past it into the box below:

Additional Comments:

Please indicate if there are specific days of the week or shifts you would prefer.

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