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Placer County Human Resources Department
#2020-14329-01


Supplemental Questionnaire

Last Name First Name
 

 

Psychiatric Nurse - I

Supplemental Questionnaire

2020-14329-01

This is the supplemental questionnaire for the classification of Psychiatric Nurse - I. Part I will not be scored or used for determining minimum qualifications but is provided for the applicant to review prior to completing the questionnaire and may also be used when determining assignment. Part II will be scored based on your checked responses.

By continuing in this examination process, you are certifying that all information provided in the supplemental questionnaire is true to the best of your knowledge. If selected for an interview, you may be required to display and respond to questions to validate your responses to this exam.

NOTE: Resumes, letters, and other materials will not be evaluated nor considered as responses to the items in this supplemental questionnaire. In addition, responses to this questionnaire will not be used for determining minimum qualifications for this position.


 

I have read and understood the above information.


 

Part I: Minimum Qualifications (Not Scored)

This section will not be scored but may assist the applicant with determining how he/she meets the minimum qualifications for this position.


1.

Do you possess the equivalent of a Bachelor's degree from an accredited college or university with major course work in nursing or a related field?

Yes No
2.

Do you possess a valid license as a Registered Nurse issued by the California Board of Registered Nursing?

Yes No
 

If yes, please provide the license number and issue date.


 

Part II: Relevant Knowledge and Experience (Scored)

This section of the supplemental questionnaire is the Civil Service examination for this position. This supplemental questionnaire will be scored based on your checked responses below. Narratives provided by applicants describing training and/or experience will not be scored, but will be available to the hiring authority and may be utilized for interview and selection determination. Scores received from this section will determine applicant ranking and placement on the eligible list.

For the items in this section, please indicate your level of training and experience and then provide a brief description of your related experience in the space provided.


1.

Do you currently possess a valid CPR certificate?

Yes No
2.

Please select all the settings where you have provided nursing care.

Hospital Setting
Outpatient Setting
Residential Setting
In-Home Care Setting
None of the above
 

If you indicated any experience, please describe.

3.

Please select all the age populations that you have provided nursing care.

Children
Adolescents
Adults
Elderly
None of the above
 

If you indicated any experience, please describe.

4.

Please select all the types of medication you have administered.

Oral
Injection
None of the above
 

If you indicated any experience, please describe.

5.

Indicate your level of knowledge overseeing medication crisis telephone calls and walk-ins.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

6.

Indicate your level of knowledge communicating medical information and patient care instructions to providers and/or other health care professionals.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

7.

Indicate your level of knowledge interpreting a physician’s order regarding patient medication needs and care.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

8.

Indicate your level of knowledge providing medication, counseling and education to patients regarding the need, purpose and side effects of prescribed medications.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

9.

Indicate your level of knowledge administering psychotropic medications to patients.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

10.

Indicate your level of knowledge interviewing, observing, and recording patients as a means of collecting psychosocial and/or medical history.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

11.

Indicate your level of knowledge using clinical supplies and equipment, including blood pressure cuff, stethoscope, syringes and needles.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.

12.

Indicate your level of knowledge of general legal and regulatory issues involved in treating the mentally ill.

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated knowledge, please briefly describe below.


 

Thank you for completing the examination portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

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A notice of your status will be sent to you after the posted final filing date.