Pharmacy Practice Residency at Palomar Medical Center

Pharmacy Practice Residency at Palomar Medical Center

Application Packet

Residency Year July 2011-June 2012

Instructions:

1. Complete Application for Residency Appointment

2. Complete Interview Date Availability form

3. Current Curriculum Vitae including academic history, employment, professional activities, and service activities.

4. Write a Letter of Intent describing your objectives in pursuing a residency. This should be no more than one page.

5. Request an Official Transcript (only pharmacy school)

6. Three Recommendations using the ASHP Standardized Form. The first two recommendations should be from: 1) At least one clinical faculty member with whom rotations have been completed; 2) pharmacy employer.

All materials should be addressed to:

Olga DeTorres, Pharm.D.

Pharmacy Residency Director

Pharmacy Department

Palomar Medical Center

555 East Valley Parkway

Escondido, CA 92025

Application for Residency Appointment

Pharmacy Practice Residency

Palomar Medical Center

Name:______

LastFirstInitial

Present Address:______

Street

______

CityStateZip

(_____)______

Phone

______

Cell phone/voicemail

Permanent Address:______

Street

______

CityStateZip

(_____)______

Phone

Email:______

Birthday:______

Birthplace:______

Citizenship:______

Submit this contact information with your letter of intent and other materials by January 3, 2011.

Interview Date Availability

Pharmacy Practice Residency

Palomar Medical Center

Name:______

Applicants will be invited for an interview on one of the following dates. Please indicate all dates on which you are available. Check multiple dates because after all candidates' dates have been submitted, only one or two of these days may be used for interviews.

____Thursday, February 2

____Friday, February 3

____Thursday, February 9

____Friday, February 10

____ Not available for any of these dates

American Society of Health System-Pharmacists

Standardized Residency Applicant Recommendation Request Form

RECOMMENDATION REQUEST FOR APPLICANT TO PHARMACY PRACTICE RESIDENCY PROGRAM

AT PALOMAR MEDICAL CENTER

To be completed by applicant: (please print or type)

Name of Applicant:______

First NameInitialLast Name

______

Street Address or PO Box

______

CityStateZip Code

Telephone Number:______

E-mail Address:______

I waive the right to review this recommendation:______

Signature of Residency Applicant

To the recommender: Olga DeTorres, PharmD

Please complete and return Department of Pharmacy

this form by January 3, 2011 to: Palomar Medical Center

555 East Valley Parkway

Escondido, CA 92025

Phone # (760) 739-3539

Fax# (760) 739-2628 (fax both sides)

LETTERS OF RECOMMENDATION MAY BE E-MAILED TO:

Applicants to the residency program specified above are required to have recommendations submitted by persons who are in a position to evaluate their qualifications for residency training. The recommender is asked to make a frank appraisal of the applicant's character, personality, abilities and suitability for a for a pharmacy residency. All comments and information provided will be kept in strictest confidence.

For the recommender to complete:

I have known the applicant for approximately _____ (months) (years). My relationship to the applicant was (or is) in the following capacity:

___ faculty advisor___ employer

___ clerkship preceptor___ supervisor

___ other faculty relationship___ other (please specify)

I know him/her: ___ very well ___ fairly well ___ only casually

Relative to persons of similar background, training and professional interests, how would you rate this applicant for each of the following characteristics? Please place an X under the rating column which best describes the applicant.

CHARACTERISTICS EVALUATED / UPPER 10% / UPPER 25% / UPPER 50% / LOWER 50% / NO BASIS FOR JUDGMENT
Academic ability
Quality of Work
Written communication skills
Oral communication skills
Leadership skills
Industriousness and perseverance
Initiative and motivation
Assertiveness
Cooperativeness
Ability to organize and manage time
Ability to work with supervisors
Ability to work with peers
Ability to work with patients
Dependability
Resourcefulness and originality
Willingness to accept constructive criticism
Personal appearance and professional demeanor
Commitment to professional practice
Emotional stability and maturity
Enthusiasm
Integrity

(continued on reverse side)

Does the applicant possess any special assets which should be noted?

Does the applicant demonstrate any weaknesses which you feel would hinder his/her ability to perform effectively in a residency program?

Other comments:

Recommendation concerning admission (check one):

___ I highly recommend this applicant. ___ I recommend this applicant, but with some reservation.

___ I recommend this applicant. ___ I am not able to recommend this applicant.

______

Signature of Recommender Date

______

Name-typed or printed

______

Title and Affiliation

______

Street address or P.O. Box

______

City State Zip

______

Telephone Number

American Society of Health System-Pharmacists

Standardized Residency Applicant Recommendation Request Form

RECOMMENDATION REQUEST FOR APPLICANT TO PHARMACY PRACTICE RESIDENCY PROGRAM

AT PALOMAR MEDICAL CENTER

To be completed by applicant: (please print or type)

Name of Applicant:______

First NameInitialLast Name

______

Street Address or PO Box

______

CityStateZip Code

Telephone Number:______

E-mail Address:______

I waive the right to review this recommendation:______

Signature of Residency Applicant

To the recommender: Olga DeTorres, PharmD

Please complete and return Department of Pharmacy

this form by January 3, 2011 to: Palomar Medical Center

555 East Valley Parkway

Escondido, CA 92025

Phone # (760) 739-3539

Fax# (760) 739-2628 (fax both sides)

LETTERS OF RECOMMENDATION MAY BE E-MAILED TO:

Applicants to the residency program specified above are required to have recommendations submitted by persons who are in a position to evaluate their qualifications for residency training. The recommender is asked to make a frank appraisal of the applicant's character, personality, abilities and suitability for a for a pharmacy residency. All comments and information provided will be kept in strictest confidence.

For the recommender to complete:

I have known the applicant for approximately _____ (months) (years). My relationship to the applicant was (or is) in the following capacity:

___ faculty advisor___ employer

___ clerkship preceptor___ supervisor

___ other faculty relationship___ other (please specify)

I know him/her: ___ very well ___ fairly well ___ only casually

Relative to persons of similar background, training and professional interests, how would you rate this applicant for each of the following characteristics? Please place an X under the rating column which best describes the applicant.

CHARACTERISTICS EVALUATED / UPPER 10% / UPPER 25% / UPPER 50% / LOWER 50% / NO BASIS FOR JUDGMENT
Academic ability
Quality of Work
Written communication skills
Oral communication skills
Leadership skills
Industriousness and perseverance
Initiative and motivation
Assertiveness
Cooperativeness
Ability to organize and manage time
Ability to work with supervisors
Ability to work with peers
Ability to work with patients
Dependability
Resourcefulness and originality
Willingness to accept constructive criticism
Personal appearance and professional demeanor
Commitment to professional practice
Emotional stability and maturity
Enthusiasm
Integrity

(continued on reverse side)

Does the applicant possess any special assets which should be noted?

Does the applicant demonstrate any weaknesses which you feel would hinder his/her ability to perform effectively in a residency program?

Other comments:

Recommendation concerning admission (check one):

___ I highly recommend this applicant. ___ I recommend this applicant, but with some reservation.

___ I recommend this applicant. ___ I am not able to recommend this applicant.

______

Signature of Recommender Date

______

Name-typed or printed

______

Title and Affiliation

______

Street address or P.O. Box

______

City State Zip

______

Telephone Number

American Society of Health System-Pharmacists

Standardized Residency Applicant Recommendation Request Form

RECOMMENDATION REQUEST FOR APPLICANT TO PHARMACY PRACTICE RESIDENCY PROGRAM

AT PALOMAR MEDICAL CENTER

To be completed by applicant: (please print or type)

Name of Applicant:______

First NameInitialLast Name

______

Street Address or PO Box

______

CityStateZip Code

Telephone Number:______

E-mail Address:______

I waive the right to review this recommendation:______

Signature of Residency Applicant

To the recommender: Olga DeTorres, PharmD

Please complete and return Department of Pharmacy

this form by January 3, 2011 to: Palomar Medical Center

555 East Valley Parkway

Escondido, CA 92025

Phone # (760) 739-3539

Fax# (760) 739-2628 (fax both sides)

LETTERS OF RECOMMENDATION MAY BE E-MAILED TO:

Applicants to the residency program specified above are required to have recommendations submitted by persons who are in a position to evaluate their qualifications for residency training. The recommender is asked to make a frank appraisal of the applicant's character, personality, abilities and suitability for a for a pharmacy residency. All comments and information provided will be kept in strictest confidence.

For the recommender to complete:

I have known the applicant for approximately _____ (months) (years). My relationship to the applicant was (or is) in the following capacity:

___ faculty advisor___ employer

___ clerkship preceptor___ supervisor

___ other faculty relationship___ other (please specify)

I know him/her: ___ very well ___ fairly well ___ only casually

Relative to persons of similar background, training and professional interests, how would you rate this applicant for each of the following characteristics? Please place an X under the rating column which best describes the applicant.

CHARACTERISTICS EVALUATED / UPPER 10% / UPPER 25% / UPPER 50% / LOWER 50% / NO BASIS FOR JUDGMENT
Academic ability
Quality of Work
Written communication skills
Oral communication skills
Leadership skills
Industriousness and perseverance
Initiative and motivation
Assertiveness
Cooperativeness
Ability to organize and manage time
Ability to work with supervisors
Ability to work with peers
Ability to work with patients
Dependability
Resourcefulness and originality
Willingness to accept constructive criticism
Personal appearance and professional demeanor
Commitment to professional practice
Emotional stability and maturity
Enthusiasm
Integrity

(continued on reverse side)

Does the applicant possess any special assets which should be noted?

Does the applicant demonstrate any weaknesses which you feel would hinder his/her ability to perform effectively in a residency program?

Other comments:

Recommendation concerning admission (check one):

___ I highly recommend this applicant. ___ I recommend this applicant, but with some reservation.

___ I recommend this applicant. ___ I am not able to recommend this applicant.

______

Signature of Recommender Date

______

Name-typed or printed

______

Title and Affiliation

______

Street address or P.O. Box

______

City State Zip

______

Telephone Number