Official SealSan Joaquin County Human Resources Division


#0722-RH3200-TM
Supplemental Questionnaire

Last Name
First Name
1.

Have you completed a Medical Assistant program of training?

If yes, please be sure the education section of the application is completed in detail.

Yes No
2.

Do you possess one (1) year of experience performing the duties of a medical or outpatient clinic assistant in a medical or clinic office which included both clerical and unlicensed assistive patient care duties?

Yes No
3.

Do you possess BOTH one (1) year as a Nursing Assistant or Hospital Unit Clerk AND the equivalent of 15 units from an accredited college or approved business school in at least three (3) of the following subject areas: medical terminology, anatomy, physiology, psychology and medical office practices? 

If yes, please be sure the education section of the application is completed in detail.

Yes No
4.

Have you successfully completed an approved Paramedic (EMT-P) education program accredited in the State of California which included clinical and didactic practices?

Yes No
5.

Please check the boxes that indicate the departments you are interested in applying for:

San Joaquin General Hospital - Ambulatory Care Services
San Joaquin County Clinics
Both
6.

This recruitment may be utilized to fill vacancies within the Special Care Clinic. This clinic provides care to an inmate patient population. Please indicate below if you want to be considered for referral to the Special Care Clinic.

Yes, please consider me for positions in the Special Care Clinic.
No, I am not interested in being referred to the Special Care Clinic.