offical seal
Placer County Human Resources Department
#2021-13551-01


Supplemental Questionnaire

Last Name First Name
 

 

Public Health Nurse - Supervising
Supplemental Questionnaire

 

This is the supplemental questionnaire for the classification of Public Health Nurse - Supervising.  Parts I and II will not be scored. Part III will be scored based on your selected responses. Narrative responses describing training and/or experience will not be scored, but will available to the hiring authority and may be utilized for interview and selection determinations.



 

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 examination.

NOTE: Resumes, letters and other materials will not be evaluated nor considered as responses to the items in this supplemental questionnaire.


 

I have read and understand the above instructions.


 

PART I - MINIMUM QUALIFICATION SCREENING (NOT SCORED)

This section will not be scored but may assist with determining how the applicant reports meeting the minimum qualifications for this classification. 


1.

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

Yes No
2.

Do you possess of a valid license as a Registered Nurse issued by the California Board of Registered Nursing?  If no, you are encouraged to review the job posting and the minimum qualifications for this position. If yes, please be sure to complete the license/certificate section of your application.

Yes No
3.

Do you possess of a valid certificate as a Certified Public Health Nurse issued by the California Board of Registered Nursing? If no, you are encouraged to review the job posting and the minimum qualifications for this position. If yes, please be sure to complete the license/certificate section of your application. 

Yes No
4.

Do you possess three years of increasingly responsible experience in public health nursing? If no, you are encouraged to review the job posting and the minimum qualifications for this position. 

Yes No
4a.

If you answered yes, please briefly describe this experience below.

If you do not have this experience, please type "none."


 

PART II: SPECIALIZED SKILLS (NOT SCORED)


1.

Are you English/Spanish bilingual?  (Placer County may administer a Spanish Language Skills Examination as part of the selection process.)

Yes No
2.

Are you English/Russian bilingual?  (Placer County may administer a Russian Language Skills Examination as part of the selection process.)

Yes No

 

PART III:  TRAINING AND EXPERIENCE (SCORED EXAMINATION)

Please answer the following questions based on your training and/or experience. Based on your selected responses, your training and experience will be scored and ranked. Narratives provided by applicants describing training and/or experience will not be scored, but will be available to the hiring authority for interview and selection determinations.


1.

Please describe your experience recommending, developing, implementing and evaluating measurable goals and objectives related to public health nursing program activities:    

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
1a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."

2.

Please describe your experience establishing schedules and methods for public health nursing activities, programs and services:    

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
2a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."

3.

Please describe your experience planning, prioritizing, assigning, supervising and reviewing the work of staff involved in various public health nursing activities and programs:    

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
3a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."

4.

Please describe your experience evaluating and recommending improvements and modifications to operations and activities of assigned responsibilities:

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
4a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."

5.

Please describe your experience evaluating and assuring the quality of nursing practices:    

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
5a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."

6.

Please describe your experience participating in the selection of staff:    

I possess no or very limited training or experience performing these tasks.
I possess limited training and/or experience performing these tasks.
I have some experience performing these tasks but would need additional training.
I have performed these tasks independently under normal supervision.
I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.
6a.

If you indicated experience performing these tasks, please describe below. 

If you do not have this experience, please type "none."


 

Thank you for completing the examination portion of the application process. 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.