Official SealSan Joaquin County Human Resources Division


#0622-RS4302-01
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


1.

PATTERN I

Do you have one year of full-time experience as a Community Health Outreach Worker Trainee in San Joaquin County Service?

Yes No
 

If you answered Yes, please identify the San Joaquin County department/unit you worked for as a Community Health Outreach Worker Trainee, dates of employment, and number of hours worked per week:

2.

PATTERN II

Do you have one year of responsible full-time paid work experience providing community based health services, working with community based organizations that provide health related services to culturally diverse groups, or working with high risk groups in the area of communicable diseases?

Yes No
 

If you answered Yes, please describe and include the following:

  • Name of employer
  • Dates of employment
  • Job Title
  • Number of hours worked per week
  • Specific job duties performed

Note:  A resume is not accepted in lieu of completing this question.  Providing all information requested relative to your experience will assist in assessing your qualifications.

3.

This position requires possession of a valid California driver's license.  Please provide your license number and expiration date.