Blank California Retake PDF Form

Blank California Retake PDF Form

The California Retake form is an application used by individuals seeking to retake the North American Pharmacist Licensure Examination (NAPLEX) or the California Practice Standards and Jurisprudence Examination (CPJE). This form is essential for those who have previously attempted these exams and wish to reapply for licensure. For a seamless application process, ensure that all required documents are submitted accurately and promptly.

To fill out the form, please click the button below.

The California Retake form is a crucial document for individuals seeking to reattempt the pharmacist licensure examinations, specifically the North American Pharmacist Licensure Examination (NAPLEX) and the California Practice Standards and Jurisprudence Examination (CPJE). Designed to streamline the application process, this form requires applicants to provide comprehensive personal information and documentation, ensuring that all details align with official identification. A notable aspect of the application is the emphasis on using one's full legal name as it appears on government-issued identification, which is vital for admission to testing sites. Additionally, the form outlines specific instructions regarding application fees, with no charge for retaking the NAPLEX but a $200 fee for the CPJE. The processing timeframe is another important consideration; applicants should expect to wait about 30 days for the board to review their submission. Incomplete applications can lead to delays or rejections, making it essential to follow all instructions carefully. Furthermore, provisions exist for military spouses or partners, allowing for expedited processing under certain conditions. The Retake form serves as a gateway for aspiring pharmacists to re-enter the examination process, underscoring the importance of meticulous preparation and adherence to guidelines.

Document Sample

 

 

 

 

California State Board of Pharmacy

BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY

1625 N. Market Blvd, Suite N219, Sacramento, CA 95834

DEPARTMENT OF CONSUMER AFFAIRS

Phone (916) 574-7900

GOVERNOR EDMUND G. BROWN JR.

Fax (916) 574-8618

 

 

www.pharmacy.ca.gov

 

 

 

 

 

 

RETAKE APPLICATION INSTRUCTIONS

APPLICATION PROCESSING TIMEFRAME

Please allow the board 30 days to process your application. The board will mail you either your eligibility letter to sit for the examination(s) or a deficiency letter if your application is incomplete.

Due to current workload the board will not be able to respond to status checks on your application unless your application has been on file for over 60 days.

Once you have completed your requirements for licensure (passing both NAPLEX and CPJE) and your bank has processed your initial license fee check, an easy way to verify if the board has issued you a license is to visit the board’s website at www.pharmacy.ca.gov under “Verify a License”, as the processing time to receive your pharmacist wallet license is 4-6 weeks from the date the license is issued.

APPLICATION INSTRUCTIONS

Print out the entire application and required forms as instructed under What Makes an Application Complete in these instructions. Please include all the required forms prior to submitting your application to the board.

PLEASE NOTE: It is very important that when you complete the application, the name you apply under IDENTICALLY matches the name on your U.S. social security card and your U.S. government issued photo identification (state issued driver’s license or state issued identification card).

FULL LEGAL NAME

It is very important that you complete your application by applying under your full legal name. Your full legal name on record with the board is the name you submit with your pharmacist licensure examination application. The board will make you eligible only under your name on record with the board and not aliases.

In order to be admitted to take the CPJE, you will need to be prepared to display at the testing site your U.S. social security card AND U.S. government issued photo identification. Your name on both forms of identification must match letter for letter with the name of record on file with the board (e.g., if your middle name is spelled out on your U.S. government issued photo identification, then your middle name must be spelled out on your U.S. social security card, and both of these identifications must match exactly to the name of record on file with the board.) The testing site will NOT allow you to sit for the CPJE without your identifications matching IDENTICALLY with your name of record on file with the board. Photocopies of your identifications will not be accepted at the testing site.

WHAT MAKES AN APPLICATION COMPLETE Before the board can classify you as eligible to take the NAPLEX and/or the CPJE, you must submit a fully completed “Retake Application” (form 17A-1A)” along with all other required documents and fees as instructed in this section. If you have requested a score transfer to California from NABP for the NAPLEX and you have sat for the NAPLEX more than once to obtain a passing score, you are required to submit a Retake Application for each NAPLEX score in order for California to request all your NAPLEX scores to be transferred by the NABP.

APPLICATION FEE: If you are submitting a Retake Application for the NAPLEX there is NO FEE. If you are applying to retake the CPJE, please submit a check, money order, or cashier’s check in the amount of $200, made payable to the Board of Pharmacy. The application fee is non-refundable. Please check the appropriate box on the application identifying the appropriate examination(s).

RETAKE APPLICATION: (form 17A-1A): The application must be completed in its entirety-- with all questions answered. Failure to do so will result in an incomplete application and a deficiency letter will be mailed to you. Failure to correct the deficiencies will result in your application being deemed abandoned.

ACTIVE DUTY MILITARY - Spouses or Partners Receive Expedited Review: The board is required to expedite the licensure process for an applicant whose spouse or partner is an active duty member of the U.S. Armed Forces and meets other criteria. (Business and Professions Code section 115.5.) If you would like to be considered for this expedited review and process, please provide the following required documentation.

1.Are you married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in California under official active duty military orders?

If “yes,” please attach a copy of the marriage certificate or certified declaration/registration of domestic partnership filed with the Secretary of State AND military orders establishing duty station in California. For other forms of “legal union” not recognized by California, you may submit other documentary evidence of legal union issued by the State that recognizes your legal union for consideration by the board in meeting this requirement.

2.Do you hold a current license in another state, district, or territory of the United States in the profession or vocation for which you seek licensure from the board?

If “yes,” please attach a copy of the current license in another state, district, or territory of the United States.

VERIFICATION OF LICENSE IN ANOTHER STATE: If you have been issued an intern pharmacist or pharmacist license in another state since you submitted your initial pharmacist examination and license application, you must request each state board or agency to verify your license on form 17A-16. You only need to submit one form 17A-16 per state.

PRACTITIONER SELF-QUERY REPORT: If you did not provide a sealed original Self-Query Report from the National Practitioner Data Bank Healthcare Integrity and Protection Data Bank ((NPDB-HIPDB) with your initial pharmacist examination and licensure application or it has been one year since you originally submitted a sealed original Self-Query Report, you are required to submit a sealed original Self-Query Report with this Retake Application. It is your responsibility to attach the sealed original NPDB-HIPDB Self-Query Report to your application.

The instructions to request a Self-Query Report are available at NPDB-HIPDB’s website: www.npdb- hipdb.hrsa.gov. The website includes a Fact Sheet on self-querying, as well as Frequently Asked Questions to assist you in requesting a report.

Practitioner Self-Query Report requests are required to be submitted through the NPDB- HIPDB web site http://www.hpdb-hipdb.hrsa.gov. NPDB-HIPDB provides a toll-free number for individuals who do not have access to the Internet.

Practitioners are required to pay a total charge of $16.00 directly to NPDB-HIPDB.

Practitioners are required to mail to NPDB-HIPDB a notarized copy of the Self-Query request to a specified address. This copy can be printed, which the practitioner prints out after filling the form out on-line.

NPDB-HIPDB provides a dispute process for a practitioner that wish to submit a statement or dispute to a report.

The board is unable to assist you with the Self-Query process. Please contact the NPDB-HIPDB Customer Service Center at: (800) 767-6732 – TDD (703) 802-9395.

MAKE TEST ARRANGEMENTS: Please follow the below instructions for each examination.

NAPLEX: Visit the National Association of Boards of Pharmacy (NABP) Web site at http://www.nabp.net/ for information on how to register for the North American Pharmacist Licensure Examination (NAPLEX). Download the NAPLEX/MPJE Bulletin (see the NABP Web site). You must register on-line and remit the $465 fee to the NABP. You may register with NABP simultaneously when submitted your pharmacist application to the board or after the board has determined you are eligible to take the pharmacist examinations. However, the NABP will not contact you until you have registered on-line and remitted the $465 fee to the NABP. Once the board has determined you are eligible and you have paid your fee to the NABP, the NABP will mail you an Authorization to Test form (ATT). At this point, you will be able to schedule the location, date and time for your NAPLEX exam. Requirements and specifications for the NAPLEX are available in the NAPLEX/MPJE Bulletin. Additionally, there is a preNAPLEX test you may take as well to prepare you for the NAPLEX. If you have already taken and passed the NAPLEX, information on how to request a Score Transfer through NABP is on their Web site.

CPJE: You will not schedule to sit for this examination until the board has made you eligible. Please allow up to 14 days after you receive the board’s notification that you are eligible for PSI to mail you a Candidate Handbook. The outside cover of the handbook is your “Notice of Eligibility.” Use the information in this handbook to contact PSI. If you do not receive the Candidate Informational Bulletin in the mail you can download the Candidate Information Bulletin from the board’s Web site. After you have paid PSI $33, you will be able to schedule an appointment to take the CPJE. Again, the board

2

encourages you to read this handbook carefully – it contains important information about the examination and procedures at the test site.

You are encouraged to read all information published about the NAPLEX and the CPJE. Failure to comply with the testing procedures may result in your examination not being graded and forfeiting of your application and/or testing fees.

SPECIAL ACCOMMODATIONS

The California State Board of Pharmacy recognizes its responsibilities under Title II of the Americans with Disabilities Act to provide reasonable accommodations, including auxiliary aids to qualified examination candidates with disabilities. However, the board will not provide an accommodation which fundamentally alters the measurement of the knowledge or skills the examination is intended to test, compromises examination security, or creates an undue financial and administrative burden.

A candidate who seeks an accommodation has the responsibility to make the request to the board and to provide reasonable documentation of the need for accommodation at least 90 days before he or she can take the written examination. The information supplied to substantiate a candidate's request for an accommodation will be kept confidential to the extent allowed by law. Information on this process is available from the board’s Web site.

INCOMPLETE APPLICATIONS

You will be notified of any deficiencies in your application only once. It is your responsibility to correct all deficiencies. Failure to correct all deficiencies within one year from the date of notice will result in your application being deemed abandoned pursuant to Business and Professions Code section 142.

You will know that you have been deemed eligible to take the examination when you receive your “Notice of Eligibility” letter from the board.

If it has been more than 30 days since you have corrected all deficiencies in your application as identified in your deficiency letter AND you have not been notified that you are eligible to take the examinations, please contact the board via email at: [email protected].

17M-29A (1.13)

3

California State Board of Pharmacy

BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY

1625 N. Market Blvd, Suite N219, Sacramento, CA 95834

DEPARTMENT OF CONSUMER AFFAIRS

Phone (916) 574-7900

GOVERNOR EDUMND G. BROWN JR.

Fax (916) 574-8618

 

www.pharmacy.ca.gov

 

RETAKE

APPLICATION FOR PHARMACIST LICENSURE AND EXAMINATION

I am submitting this application to retake: NAPLEX only

CPJE only ($200) Both CPJE ($200) and NAPLEX

(Note: There is a $200 fee (made payable to the California State Board of Pharmacy) for retaking the CPJE. There is no California State Board of Pharmacy fee to retake the NAPLEX.)

Your full legal name on file with the board must match IDENTICALLY with both your U.S. government issued photo identification and U.S. issued social security card for admission to the California Practice Standards and Jurisprudence Examination for Pharmacists (CPJE). If your identifications do not match, you will need to correct your identifications so that the names match identically. Your original U.S. government issued photo identification and U.S. issued social security card are required for admission at the CPJE examination site. All items of information requested in this application are mandatory.

Failure to provide any of the requested information will result in the application being rejected as incomplete. Pages 1, 2, and 3 of the retake application must be completed and signed by the applicant.

Applicant Information - Please Type or Print

MILITARY SPOUSES/PARTNERS (Check here if you are relocating to CA as a result of your spouse’s/partner’s active duty military service.)

Full Legal Name-Last Name:

 

 

First Name:

Middle Name:

 

Previous Names (AKA, Maiden Name, Alias, etc):

 

 

 

 

 

*Official Mailing/Public Address of Record (Street Address, PO Box #, etc):

 

 

 

City:

 

 

 

State:

 

Zip Code:

 

Residence Address (if different from above):

 

 

 

 

 

City:

 

 

 

State:

 

Zip Code:

 

Hm#: (

)

Cell#: (

)

Wk#: (

)

Email Address:

 

Date of Birth (Month/Day/Year):

 

 

**Social Security No:

 

Driver’s License No:

State:

List all state(s) where you are currently licensed or held a license as a pharmacist, intern pharmacist, and pharmacy technician. (Attach additional sheet of paper if necessary)

State

Registration Number

Active or Inactive

Expiration Date

Self-Query Report by the National Practitioner Data Bank Healthcare Integrity and Protection Data Bank (NPDB-HIPDB) Required if you have not submitted a Self-Query Report with your initial application or if it has been over one year since you last submitted a Self-Query Report to the board.

Attached is the sealed envelope containing my Self-Query Report from the NPDB-HIPDB. (This must be submitted with your application.)

THIS SECTION IS FOR BOARD USE ONLY

 

Photo:

FP Cards:

 

 

Exam History

 

 

 

 

 

 

 

 

CASHIERING ONLY

 

Security:

FP Fees:

 

Date

NAPLEX

 

CPJE

 

APPLICATION FEE

 

 

 

 

 

 

 

 

 

Receipt No.

 

Enf Check

DOJ Clear Date: _______

 

 

 

 

 

 

 

 

 

SQ-HIPDB

FBI Clear Date: _______

 

 

 

 

 

 

 

 

Date Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transcript:

FG

 

 

 

 

 

 

 

 

Amount

 

 

School Code : ____

 

 

 

 

 

 

 

 

 

 

 

 

TSE

 

 

 

 

 

 

 

 

LICENSE FEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Intern Hours:

 

 

C/I:

 

Intern Permit #

 

 

Receipt No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSURE VERIFICATION

 

 

 

 

 

 

 

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL APPLICANTS MUST ANSWER THE FOLLOWING QUESTIONS (Attach additional sheet of paper if necessary)

1.

Have you ever been expelled from a pharmacist licensure exam administered in this state or any other state?

Yes

No

 

If “yes,” provide the date and state. ___________________________________

 

 

 

2.

Have you previously taken a pharmacist exam which was not graded or had exam results

 

Yes

No

 

withheld on grounds of dishonest conduct during an examination in this state or any other state?

 

 

 

If “yes,” provide the date and state. _________________________________________

 

 

 

3.

Do you have a medical condition which in any way impairs or limits your ability to practice your profession

Yes

No

 

with reasonable skill and safety without exposing others to significant health or safety risks?

 

 

 

 

If “yes,” attach a statement of explanation. If “no,” proceed to #4.

 

 

 

 

 

Are the limitations caused by your medical condition reduced or improved because you receive ongoing

 

 

 

treatment or participate in a monitoring program?

Yes

No

 

 

 

If “yes,” attach a statement of explanation.

 

 

 

 

 

If you do receive ongoing treatment or participate in a monitoring program, the board will make an

 

 

 

individualized assessment of the nature, the severity and the duration of the risks associated with an ongoing

 

 

 

medical condition to determine whether an unrestricted license should be issued, whether conditions should

 

 

 

be imposed, or whether you are not eligible for licensure.

 

 

 

 

4.

Do you currently engage, or have you been engaged in the past two years, in the illegal use of controlled

Yes

No

 

substances?

 

 

 

 

 

If “yes,” are you currently participating in a supervised rehabilitation program or professional assistance

 

 

 

program which monitors you in order to assure that you are not engaging in the illegal use of controlled

 

 

 

substances?

Yes

No

 

 

 

Attach a statement of explanation.

 

 

 

 

5.

Has disciplinary action ever been taken against your pharmacist license, intern permit or technician

Yes

No

 

registration in this state or any other state?

 

 

 

 

 

If “yes,” attach a statement of explanation to include circumstances, type of action, date of action and

 

 

 

type of license, registration or permit involved.

 

 

 

 

6.

Have you ever had an application for a pharmacist license, intern permit or technician registration denied in

Yes

No

 

this state or any other state?

 

 

 

 

 

If “yes,” attach a statement of explanation to include circumstances, type of action, date of action

 

 

 

and type of license, registration or permit involved.

 

 

 

 

7.

Have you ever had a pharmacy permit, or any professional or vocational license or registration, denied or

Yes

No

 

disciplined by a government authority in this state or any other state?

 

 

 

 

 

If “yes,” provide the name of company, type of permit, type of action, year of action and state.

 

 

 

______________________________________________________________

 

 

 

 

 

 

 

8.

Have you ever been convicted of any crime in any state, the USA and its territories, military court or foreign

Yes

No

 

country?

 

 

 

 

 

Check the box next to “YES” if, you have ever been convicted or plead guilty to any crime. “Conviction”

 

 

 

includes a plea of no contest and any conviction that has been set aside or deferred pursuant to Sections

 

 

 

1000 or 1203.4 of the Penal Code, including infractions, misdemeanor, and felonies. You do not need to

 

 

 

report a conviction for an infraction with a fine of less than $300 unless the infraction involved alcohol or

 

 

 

controlled substances. You must, however, disclose any convictions in which you entered a plea of no

 

 

 

contest and any convictions that were subsequently set aside pursuant or deferred pursuant to sections 1000

 

 

 

or 1203.4 of the Penal Code.

 

 

 

 

 

Check the box next to “NO” if you have not been convicted of a crime.

 

 

 

 

Please provide the following information in order to assist in the process of your application: 1) certified copies of the arresting agency report; 2) certified copies of the court documents; 3) and a descriptive explanation of the circumstances surrounding the conviction (i.e. dates and location of incident and all

circumstances surrounding the incident.) If documents were purged by the arresting agency and/or court, a letter of explanation from these agencies is required. Failure to disclose a disciplinary action or conviction may result in the license being denied or revoked for falsifying the application

 

Arrest Date

Conviction Date

 

Violation(s)

Case #

Court of Jurisdiction (Full Name and Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You must provide a written explanation for all affirmative answers. Failure to do so will result in this application being deemed withdrawn or incomplete.

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APPLICANT AFFIDAVIT

You must provide a written explanation for all affirmative answers. Failure to do so will result in this application being deemed incomplete. Falsification of the information on this application may constitute grounds for denial or revocation of the license.

All items of information requested in this application are mandatory. Failure to provide any of the requested information will result in the application being rejected as incomplete.

Collection and Use of Personal Information. The California State Board of Pharmacy of the Department of Consumer Affairs collects the personal information requested on this form as authorized by Business and Professions Code Sections 4200 and 4209 and Title 16 California Code of Regulations Section 1719-1720.1 and 1728. The California State Board of Pharmacy uses this information principally to identify and evaluate applicants for licensure, issue and renew licenses, and enforce licensing standards set by law and regulation.

Mandatory Submission. Submission of the requested information is mandatory. The California State Board of Pharmacy cannot consider your application for licensure or renewal unless you provide all of the requested information.

Access to Personal Information. You may review the records maintained by the California State Board of Pharmacy that contain your personal information, as permitted by the Information Practices Act. The official responsible for maintaining records is the Executive Officer at the board’s address listed on the application. Each individual has the right to review the files or records maintained by the board, unless confidential and exempt by Civil Code Section 1798.40.

Possible Disclosure of Personal Information

We make every effort to protect the personal information you provide us. The information you provide, however, may be disclosed in the following circumstances:

In response to a Public Records Act request (Government Code Section 6250 and following), as allowed by the Information Practices Act (Civil Code Section 1798 and following);

To another government agency as required by state or federal law; or

In response to a court or administrative order, a subpoena, or a search warrant.

*Once you are licensed with the board, the address of record you enter on this application is considered public information pursuant to the Information Practices Act (Civil Code section 1798 et seq.) and the Public Records Act (Government Code Section 6250 et seq.) and will be placed on the Internet. This is where the board will mail all correspondence. If you do not wish your residence address to be available to the public, you may provide a post office box number or a personal mail box (PMB). However, if your address of record is not your residence address, you must also provide your residence address to the board, in which case your residence will not be available to the public.

**Disclosure of your U.S. social security account number is mandatory. Section 30 of the Business and Professions Code, Section 17520 of the Family Code, and Public Law 94-455 (42 USC § 405(c)(2)(C)) authorize collection of your social security account number. Your social security account number will be used exclusively for tax enforcement purposes, for purposes of compliance with any judgment or order for child or family support in accordance with section 17520 of the Family Law Code, or for verification of license or examination status by a licensing or examination entity which utilizes a national examination and where licensure is reciprocal with the requesting state. If you fail to disclose your social security account number, your application will not be processed and you may be reported to the Franchise Tax Board, which may assess a $100 penalty against you.

NOTICE: Effective July 1, 2012, the State Board of Equalization and the Franchise Tax Board may share taxpayer information with the board. You are obligated to pay your state tax obligation. This application may be denied or your license may be suspended if the state tax obligation is not paid.

MANDATORY REPORTER

Under California law, each person licensed by the Board of Pharmacy is a “mandated reporter” for both child and elder abuse or neglect purposes.

California Penal Code Section 11166 and Welfare and Institutions Code Section 15630 require that all mandated reporters make a report to an agency specified in Penal Code Section 11165.9 and Welfare and Institutions Code Section 15630(b)(1) [generally law enforcement, state, and/or county adult protective services agencies, etc.] whenever the mandated reporter, in his or her professional capacity or within the scope of his or her employment, has knowledge of or observes a child, elder and/or dependent adult whom the mandated reporter knows or reasonably suspects has been the victim of child abuse or elder abuse or neglect. The mandated reporter must contact by telephone immediately or as soon as possible, to make a report to the appropriate agency(ies) or as soon as is practicably possible. The mandated reporter must prepare and send a written report thereof within two working days or 36 hours of receiving the information concerning the incident.

Failure to comply with the requirements of Section 11166 and Section 15630 is a misdemeanor, punishable by up to six months in a county jail, by a fine of one thousand dollars ($1,000), or by both that imprisonment and fine.

For further details about these requirements, consult Penal Code Section 11164 and Welfare and Institutions Code Section 15630, and subsequent sections.

APPLICANT AFFIDAVIT

(must be signed and dated by the applicant)

I,

 

, hereby attest to the fact that I am the applicant whose signature appears

 

(Print full name)

below. I hereby certify under penalty of perjury under the laws of the State of California to the truth and accuracy of all statements, answers and representations made in this application, including all supplementary statements. I also certify that I have read the instructions attached to this application.

 

Signature of Applicant

Date

 

 

 

17A-1A (1.13)

3

File Specifics

Fact Name Details
Governing Body The California State Board of Pharmacy oversees the Retake Application process.
Processing Time Allow 30 days for the board to process the application.
Eligibility Notification Applicants will receive either an eligibility letter or a deficiency letter by mail.
Application Fee No fee for NAPLEX retake; a $200 fee applies for CPJE retake.
Full Legal Name Requirement Applicants must use their full legal name as it appears on their social security card and ID.
Self-Query Report A sealed original Self-Query Report from the NPDB-HIPDB is required if not previously submitted.
Application Completeness All sections of the Retake Application must be completed to avoid rejection.
Military Spouse Expedited Review Active duty military spouses or partners may receive expedited application processing.
Identification Matching Identifications must match identically; discrepancies will result in denial of entry to the exam.
Business and Professions Code The application process is governed by California Business and Professions Code sections 115.5 and 142.

How to Use California Retake

Completing the California Retake form requires careful attention to detail to ensure that all necessary information is accurately provided. After submitting the form, applicants can expect a processing timeframe of approximately 30 days. During this period, the board will either send an eligibility letter or a deficiency letter if the application is incomplete. It is crucial to follow each step thoroughly to avoid delays.

  1. Print out the entire Retake Application (form 17A-1A) and any required forms as specified in the application instructions.
  2. Ensure that your full legal name matches exactly with your U.S. social security card and government-issued photo ID.
  3. Complete all sections of the application, providing all requested information. Incomplete applications will result in delays.
  4. If applying to retake the CPJE, include a non-refundable fee of $200, made payable to the California State Board of Pharmacy.
  5. For military spouses or partners seeking expedited review, attach the necessary documentation, including a marriage certificate or domestic partnership registration along with military orders.
  6. If applicable, request verification of your license from other states using form 17A-16 and submit it with your application.
  7. Attach a sealed original Self-Query Report from the National Practitioner Data Bank if required.
  8. Double-check that all items are completed and signed on pages 1, 2, and 3 of the application.
  9. Submit the completed application and all attachments to the California State Board of Pharmacy at the specified address.

Your Questions, Answered

  1. What is the California Retake Form?

    The California Retake Form is an application that allows individuals to apply for permission to retake the NAPLEX and/or CPJE examinations. This form is essential for those who did not pass these exams on their first attempt and wish to try again.

  2. What is the application fee for the Retake Form?

    If you are retaking the NAPLEX, there is no fee. However, if you are retaking the CPJE, you need to submit a fee of $200. This payment must be made by check, money order, or cashier's check made out to the California State Board of Pharmacy.

  3. How long does it take to process the application?

    The processing time for your application is typically around 30 days. After this period, you will receive either an eligibility letter or a deficiency letter if there are issues with your application.

  4. What happens if my application is incomplete?

    If your application is incomplete, you will receive a deficiency letter from the board. You must correct the deficiencies within one year; otherwise, your application will be deemed abandoned.

  5. What identification do I need to bring to the testing site?

    You must bring both your U.S. social security card and a U.S. government-issued photo identification. The names on both forms of ID must match exactly with the name on your application. If they do not match, you will not be allowed to take the exam.

  6. Can I check the status of my application?

    You can check the status of your application only if it has been over 60 days since you submitted it. Before that, the board will not respond to status inquiries due to their workload.

  7. What if I am a military spouse or partner?

    If you are a spouse or partner of an active-duty military member, you may qualify for an expedited review process. You will need to provide documentation, such as a marriage certificate and military orders, to be considered for this expedited process.

  8. What is a Self-Query Report?

    A Self-Query Report is a document from the National Practitioner Data Bank that provides information about your professional history. If you have not submitted this report with your initial application or if it has been over a year since your last submission, you will need to include a sealed original report with your Retake Application.

  9. What should I do if I have a medical condition?

    If you have a medical condition that may affect your ability to practice safely, you must disclose this in your application. You should also provide a statement explaining your condition and any ongoing treatment you are receiving.

  10. How do I make test arrangements for the NAPLEX and CPJE?

    For the NAPLEX, you must register online with the National Association of Boards of Pharmacy and pay a fee of $465. For the CPJE, you will receive instructions after the board confirms your eligibility. You will need to pay a fee of $33 to schedule your appointment.

Common mistakes

  1. Not Matching Legal Names: One of the most common mistakes is failing to ensure that the name on the application matches exactly with the name on your U.S. social security card and government-issued photo ID. Even small discrepancies, such as missing middle names or initials, can lead to application rejection.

  2. Incomplete Application Submission: Submitting an incomplete application is another frequent error. Ensure that all sections of the Retake Application (form 17A-1A) are filled out completely. Missing information will result in a deficiency letter, which can delay your eligibility.

  3. Ignoring Fee Requirements: Applicants often overlook the fee structure. While there is no fee to retake the NAPLEX, a fee of $200 is required for the CPJE. Be sure to submit the correct payment and check the appropriate box on the application to avoid complications.

  4. Neglecting to Attach Required Documents: Failing to include necessary documents, such as the Self-Query Report from the National Practitioner Data Bank, can lead to application abandonment. Always double-check the list of required attachments before submitting your application.

  5. Not Following Up on Application Status: After submitting your application, many applicants forget to follow up. If you haven’t received a notification within 30 days, it’s wise to contact the board to check on the status and ensure that there are no outstanding issues.

Documents used along the form

The California Retake form is a crucial document for individuals seeking to retake the NAPLEX or CPJE examinations. Along with this form, several other documents may be required to ensure a complete application. Below is a list of these additional forms and documents, each serving a specific purpose in the application process.

  • Verification of License in Another State: This document is needed if the applicant holds a current license in another state. It verifies the status of that license through form 17A-16, which must be submitted for each state where the applicant is licensed.
  • Practitioner Self-Query Report: Required if the applicant has not submitted a Self-Query Report from the National Practitioner Data Bank (NPDB-HIPDB) with their initial application or if it has been over one year since the last submission. This report must be sealed and included with the application.
  • Application Fee Payment: For those retaking the CPJE, a fee of $200 must be submitted with the application. This fee is non-refundable and should be made payable to the California State Board of Pharmacy.
  • Military Spouse Documentation: Applicants who are spouses or partners of active duty military personnel may submit documentation for expedited processing. This includes a marriage certificate or proof of domestic partnership along with military orders.
  • Identification Verification: Applicants must provide a U.S. government-issued photo ID and a Social Security card. The names on these documents must match exactly with the name on the application.
  • Test Arrangement Confirmation: This includes instructions for scheduling the NAPLEX and CPJE examinations after receiving eligibility notification from the board. It details the necessary steps and fees involved in the registration process.
  • Incomplete Application Notification: If any deficiencies are found in the application, the board will notify the applicant. It is the applicant's responsibility to address these deficiencies within one year to avoid abandonment of the application.

Submitting the California Retake form alongside these additional documents ensures a complete application, helping to facilitate the examination process. It is essential for applicants to carefully follow the instructions and provide all necessary information to avoid delays.

Similar forms

The California Retake form shares similarities with the application for a professional license in various fields, such as nursing. Like the Retake form, nursing applications require candidates to submit detailed personal information, including their full legal name and identification. Both documents emphasize the importance of accuracy in personal details, as discrepancies can lead to delays or rejection of the application. Additionally, both forms necessitate the submission of supporting documents, such as proof of prior education and examination results, to establish eligibility for licensure.

Another document comparable to the California Retake form is the application for the United States Medical Licensing Examination (USMLE). Candidates for the USMLE must provide comprehensive personal information and identification, similar to the requirements outlined in the Retake form. Both applications require candidates to demonstrate their eligibility through the submission of transcripts and examination scores. Furthermore, both processes include a review period during which candidates may receive notifications regarding the status of their applications, including any deficiencies that need to be addressed.

The Graduate Record Examination (GRE) registration form also exhibits similarities with the California Retake form. Both documents require applicants to provide personal information and ensure that their details match official identification documents. In addition, candidates for the GRE must submit their scores and previous academic records to confirm their eligibility for graduate programs. The GRE registration process, like the Retake application, emphasizes the importance of meeting specific deadlines and adhering to the guidelines set forth by the respective governing bodies.

The application for the Law School Admission Test (LSAT) bears resemblance to the California Retake form in its structure and requirements. LSAT applicants must complete a detailed application, providing personal information and ensuring that it matches their identification. Both forms require candidates to submit supporting documents and pay associated fees. Additionally, both processes involve a verification period during which candidates may be informed of their application status and any outstanding requirements that need to be fulfilled.

The National Council Licensure Examination (NCLEX) application is another document similar to the California Retake form. Both applications necessitate the submission of personal information and identification that must align precisely with official records. Candidates for the NCLEX must also provide proof of education and eligibility, paralleling the requirements of the Retake form. Furthermore, both applications include a processing timeframe, during which candidates can expect to receive updates regarding their application status and any necessary actions to complete the process.

Lastly, the application for a real estate license in California shares commonalities with the California Retake form. Both documents require applicants to provide their full legal name and ensure that it matches their identification. Additionally, both applications necessitate the submission of educational transcripts and examination results to demonstrate eligibility for licensure. The review process for both forms includes a timeline during which applicants are notified of their application status, including any deficiencies that may need to be corrected before moving forward.

Dos and Don'ts

When filling out the California Retake form, it is essential to follow specific guidelines to ensure a smooth application process. Here are seven things you should and shouldn't do:

  • Do ensure your full legal name matches exactly with your U.S. social security card and government-issued photo ID.
  • Don't use nicknames or aliases on your application; only your legal name is acceptable.
  • Do print the entire application and all required forms before submission.
  • Don't submit the application without answering all questions; incomplete applications will be rejected.
  • Do attach all necessary documents, including the Self-Query Report if required.
  • Don't forget to pay the appropriate fees; there is no fee for NAPLEX retakes, but a $200 fee is required for CPJE retakes.
  • Do contact the board if you have not received a response within the specified timeframe.

Misconceptions

Below is a list of common misconceptions regarding the California Retake form, along with clarifications for each:

  • Misconception 1: There is a fee to retake the NAPLEX.
  • In fact, there is no fee required for submitting a Retake Application for the NAPLEX.

  • Misconception 2: You can use an alias or nickname on the application.
  • The application must be completed using your full legal name as it appears on your U.S. social security card and government-issued ID.

  • Misconception 3: Photocopies of identification are acceptable at the testing site.
  • Only original forms of identification will be accepted. Photocopies will not be permitted.

  • Misconception 4: You will be notified of application deficiencies multiple times.
  • Notification of deficiencies occurs only once. It is the applicant's responsibility to address these issues.

  • Misconception 5: You can submit an incomplete application and fix it later.
  • Submitting an incomplete application will result in a deficiency letter. If not corrected, the application may be deemed abandoned.

  • Misconception 6: The application processing time is quick.
  • Applicants should allow up to 30 days for the board to process their application.

  • Misconception 7: You can check the status of your application anytime.
  • Status checks will only be answered if the application has been on file for over 60 days due to current workload.

  • Misconception 8: All required documents must be submitted after the application is filed.
  • All required forms must be included with the application upon submission to avoid delays.

  • Misconception 9: Military spouses receive expedited review automatically.
  • Military spouses must provide specific documentation to qualify for expedited processing.

Key takeaways

When filling out and using the California Retake form, it is important to keep the following key takeaways in mind:

  • Application Processing Time: Expect a processing time of approximately 30 days. You will receive either an eligibility letter or a deficiency letter if your application is incomplete.
  • Full Legal Name Requirement: Ensure that your application reflects your full legal name exactly as it appears on your U.S. social security card and government-issued photo ID. Discrepancies will prevent you from taking the examination.
  • Application Completeness: Submit a fully completed Retake Application (form 17A-1A) along with all required documents and fees. Incomplete applications will result in a deficiency letter and could be deemed abandoned if not corrected within one year.
  • Application Fees: There is no fee to retake the NAPLEX, but a $200 fee is required for the CPJE. This fee is non-refundable, so be sure to check the appropriate box on the application.
  • Special Accommodations: If you require accommodations under the Americans with Disabilities Act, submit your request and documentation at least 90 days prior to the examination date to ensure proper arrangements.