Official SealSan Joaquin County Human Resources Division


#0622-RH2001-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid license as a Vocational Nurse issued by the State of California, Board of Vocational Nurse and Psychiatric Technician Examiners; or, a valid Interim Permit issued by the Board? (A copy of the license must be submitted with the employment application.)
Yes No
 

If you answered yes, please identify:

  • Vocational Nurse license number
  • Date of expiration