Official SealSan Joaquin County Human Resources Division


#0522-RH1104-A5
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a Bachelor's degree in Nursing or a closely related field?

Please ensure that the information is clearly identified in the Education section of the employment application.

Yes No
2.

Please provide your RN license number below:

3.

In order to be eligible for the Staff Nurse IV in the Family Maternity Center, the following classes or courses must have been successfully completed. Please check all that apply:

Note: Please submit copies of all certifications with the completed employment application, or send via email to alhandelman@sjgov.org,  or fax to (209) 468-0508.

Fetal Heart Monitoring Class
Neonatal Resuscitation Class
Preceptor Class or Equivalent
Advanced Fetal Heart Monitoring Class
National Certification
None of the above
4.

Please provide the number of years of full time (40 hours per week) paid RN experience in a Family Maternity Center that you possess: 

Less than 1 year of RN experience in a Family Maternity Center
1-2 years of RN experience in a Family Maternity Center
More than 2 years of RN experience in a Family Maternity Center
I do not possess any RN experience in a Family Maternity Center