To submit this application, complete the form accurately and ensure all required documents are included. You can submit the application by mailing it to the Office of the Professions at the address provided in the form. Ensure the appropriate fee of $175 is included, and remember to sign the form in the presence of a Notary Public.

The application for licensure must be submitted with the required fee by May 1 for July licensing or by November 1 for January licensing annually. Renewals must be completed prior to the expiration of your current license. Staying informed on these dates is crucial for maintaining your licensure status.

The purpose of this form is to serve as an official application for individuals seeking licensure as pharmacy technicians in New York. It ensures that applicants provide all necessary personal, educational, and legal information for review. By completing this form, individuals demonstrate their qualifications and compliance with state regulations to obtain a pharmacy technician license.

• 1. Social Security Number: A unique identifier essential for tracking employment and compliance.
• 2. Birth Date: Required for age verification and identification.
• 3. Print Name: Applicant's full name as it should appear on official documents.
• 4. Mailing Address: Current address for correspondence and notifications.
• 5. Telephone/Email Address: Contact information for the department to reach the applicant.
• 6. New York State DMV ID Number: An optional field for those with a driver's license or non-driver ID.
• 7. Name on Credentials: To ensure proper identification against academic qualifications.
• 8. Certification Information: Details of pharmacy technician certifications held by the applicant.
• 9. Criminal History Questions: A series of questions about legal history and professional conduct.
• 10. Child Support Status: To ensure compliance with child support obligations.
• 11. Citizenship/Immigration Status: To verify eligibility based on citizenship requirements.

Failure to submit this form can result in delays or denials of licensure as a pharmacy technician. Without a completed application, you will not be able to practice legally, which can affect your job prospects in the field. It is crucial to adhere to the submission guidelines and deadlines to avoid complications.

• Delays in Processing: Incomplete applications may take longer to process, delaying your licensure.
• Legal Consequences: Practicing without a license can have legal repercussions for the individual.
• Employment Opportunities: Many employers require proof of licensure, which cannot be obtained without this form.

• 1. First-Time Application: When you are applying for your pharmacy technician license for the first time.
• 2. License Transfer: If you are moving to New York and need to switch your license.
• 3. License Renewal: When your current license is nearing expiration and requires renewal.