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Placer County Human Resources Department
#2020-14305-01


Supplemental Questionnaire

Last Name First Name
 

 

REGISTERED NURSE

Supplemental Questionnaire

 

 PART I - MINIMUM QUALIFICATIONS (NOT SCORED)

This section will not be scored but may assist with determining how the applicant reports meeting the minimum qualifications for this position. Possession of the following license and experience demonstrates the required knowledge, skills and abilities for this classification.


1.

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

If yes, ensure that the Certificate/License section of your application is completed.  If no, you are encouraged to review the job posting and minimum qualifications for this position.

Yes No
2.

Do you possess the equivalent to one year of responsible nursing experience in an approved hospital, clinic, or nursing home? 

Yes No
 

If you answered yes, please describe the experience below. If you answered no, please type "none."


 

PART II - TRAINING AND EXPERIENCE (SCORED EXAMINATION)

Please answer the following questions based on your training and/or experience. Based on your checked responses, your job-related training and experience will be scored and then ranked. 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 determinations.

 


1.

Performing nursing services necessary for the efficient operation of a diagnostic and/or treatment clinic in a Health and Human Services Department and/or at other center?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

2.

Assisting physicians and mid-level practitioners with examination and treatment of patients?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

3.

Assessing patient needs? 

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

4.

Counseling patients and providing information as appropriate to patient and family?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

5.

Responding to inquiries from the public or patients in person or by telephone?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

6.

Consulting with nursing staff, physicians and other medical personnel as necessary?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

7.

Administering prescribed medication, both orally and by injection?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

8.

Taking proper care of specimens obtained?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

9.

Distributing and maintaining inventory of clinic supplies?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

10.

Maintaining charts, records and reports?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

11.

Handling special complicated billings and charges?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

12.

Applying nursing principles, methods and procedures with emphasis on clinic operations?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

13.

Working in a tactful and effective manner with differing cultural, religious, economic and social groups in connection with the delivery of health care services?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

14.

Utilizing and maintaining electronic health records?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please describe below.

15.

Administering an EKG?

I have no, or a very limited amount of experience performing this task.
I have been trained with how to complete this task but have not done so in a job setting.
I have experience performing this task under close supervision.
I have experience performing this task under normal supervision.
I have experience performing this task and have trained and/or provided consultation to others.
 

If you indicated experience in performing this task, please 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.

Please Save & Continue to move forward to the next tab. 

Be sure to select the "Submit" button once the application has been completed.  You will receive confirmation that the application has been submitted.  

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