All Applicants must sign the following Application Statement and agree to all policies and procedures and the terms and conditions of the Pharmacy Benefit Management Technical Certification Program prior to being accepted as a candidate.
I hereby apply to become certified as a Pharmacy Benefit Management Certified Technician (PBMCT). I have received a copy of the PBMCT Handbook, have read it, understand it and agree to be bound by it and all policies and procedures of the PBMT Certification Program. I will review and accept updates and amendments to the PBMT Certification Program Handbook and policies as they may be amended from time to time, including without limitation those posted on the Program’s website: PBMCT.com.
I certify that I meet all of the eligibility requirements to become a candidate for certification and I certify that the information contained in this application has been completed in good faith and is true and complete. I understand that the PBMT Certification Program may require additional information and I agree to supply this information if/ when requested. I authorize the PBMT Certification Program to contact any organization or person in connection it deems necessary to verify the information I have provided with my application. All materials supplied to the PBMT Certification Program, become property of the PBMT Certification Program once submitted with my application.
I certify that I will act in a way that is consistent with the PBMCT’s Code of Conduct and other applicable Program policies. I will report to the PBMT Certification Program, any charge, complaint or ethics-related matters concerning within 30 days the date of the occurrence. I agree to maintain the confidentiality of all examination materials and agree not to disclose, publish, reproduce, or distribute examination information. I agree to cooperate with any subsequent investigation regarding such matters. I understand that if any information provided by me is later deemed to be false, the PBMT Certification Program reserves the right to revoke my certification. I agree to comply with all disciplinary or corrective action decisions of the PBMT Certification Program, including suspension or revocation of my certification. If my certification is suspended or revoke, I agree to cease use of the PBMCT certification designation. If appeal of an adverse decision is pursued, per the Policy and Procedures of the Program, I agree to crease use of the PBMCT certification until such time as the Program’s Board of Directors has determined the outcome of this appeal.
I understand that PBMT Certification Program and contracted Program vendors may collect, transmit, transfer, use, save, deliver and otherwise process Candidate information for analysis, marketing, or other purpose deemed necessary to operate the PBMT Certification Program. I hereby authorize the PBMT Certification Program to disclose and share my name as well as any other basic demographic information required to help verify my certification status.
I hereby release, discharge, and exonerate the PMBT Certification Program, its directors, officers, members, employees, representatives, agents and parent company(ies) from any and all actions, suits (including third-party suites), complaints, losses or damages, liability claims or demands, including attorney fees, arising out of, or related to any aspect of the application process including results or any other decision that may result in a decision to not issue me a certification, or related to my certification, my use of and display of my certification or references to the PBMT Certification Program, my activities and services. I understand that the PBMCT Certification does not represent licensure or work authorization.
Please type your name below. By signing this application, you affirm that the information entered is accurate, current, complete and truthful.