Official SealSan Joaquin County Human Resources Division


#0622-RS1071-TM
Supplemental Questionnaire

Last Name
First Name
1.

Have you graduated from an accredited four year college or university?

Yes No
2.

Substitution:  Full-time experience working with children in a recreational, educational, counseling, or childcare setting may be substituted for the above education on a year-for-year basis to a maximum of two years. (24 units equates to one year).

I have graduated from an accredited four year college or university and will not be substituting with experience.
I have two years of schooling completed (48 units) and two years of full-time experience working with children in a recreational, education, counseling, or childcare setting.
I have three years of schooling completed (72 units) and one year of full-time experience working with children in a recreational, educational, counseling, or childcare setting.
I do not possess any of the following substitution experience/education.
3.

Do you possess a valid California driver's license?

Yes No
 

Please provide your California driver's license expiration date:

4.

The shelter is a 24-hour facility. Prior to an employee's start date, he/she must successfully pass a Department of Justice background check, drug screen, physical exam and meet CCL requirements. Employees must also be able to work varying shifts, weekends, holidays and/or overtime as needed.

Below is a listing of the various shift schedules*.   Please check the shifts you would be available to work. Check all that apply:

*Specific shift hours may vary based on the needs of the Shelter and census numbers.

Day Shift: 6:30 am - 2:30 pm
Swing Shift: 2:00 pm - 10:00 pm
Late Swing Shift: 5:00 pm - 1:00 am
Graveyard Shift: 9:00 pm - 7:00 am