Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name
Have you graduated from an accredited college or university with major course work in dietetics, nutrition, or a closely related field including or supplemented by the completion of a dietary internship at an approved institution?
Yes No

If yes, please specify:


  • name of program/school:
  • start of program/school:
  • date of program completion: 
  • date certificate/degree received:
Do you have two years of professional dietetics work experience, including a minimum of one year in an institutional setting.
Yes No

If you answered yes to the previous question, please specify for each position:


  • Job title
  • Name of facility/business
  • Specific duties
  • Dates of employment
  • Number of hours per week worked
Do you possess current registration as a Dietitian with the American Dietetic Association?
Yes No
If yes, please enter your RD registration number below: