Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name

Do you possess a valid Respiratory Care Practitioner license issued by the State of California Respiratory Care Board?

A copy of the license must be submitted with the employment application.

Yes No

Please provide your Respiratory Care Practitioner license number. (Write "none" if you do not possess a valid California Respiratory Care Practitioner license.)


By checking this box, I acknowledge and accept that an offer of employment is conditional upon my ability to provide proof of high school diploma or equivalent as a required by the California Association of Pathology.


Position(s) may rotate or be assigned to the Medical Guarded Unit. As a condition of employment, candidates assigned to the Medical Guarded Unit must successfully pass a California Department of Corrections (CDCR) background investigation conducted by the California Department of Corrections and Rehabilitation. Candidates must also maintain their CDCR clearance for continued employment in this unit. Please check the below box to acknowledge you understand and will comply with the above terms.

Yes, I acknowledge and understand the above terms.