Official SealSan Joaquin County Human Resources Division


#0722-RC0506-AC
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess two years as a Maintenance Worker in San Joaquin County service?
Yes No
1a.

If you answered "Yes" to Question No. 1, please provide:

  • Dates of employment
  • Hours worked per week
  • If employed part-time/temporary, include from/to dates
2.

PATTERN II

Do you possess at least one year of full-time, journey-level tree trimming work experience with a commercial or governmental tree maintenance organization?
Yes No
2a.

If you answered "Yes" to Question No. 2, please provide the name of your employer, dates of employment, number of hours worked per week, and a detailed description of the duties you performed.
2b.

Please indicate if your journey-level tree trimming work experience included the following (check all that apply):
Climbing and working in large trees
Using aerial platforms
Use of chippers
Use of chain saws
Climbing ropes
All of the above
None of the above
3.

Please provide:

  • Current valid California driver's license number
  • Expiration date (mm/dd/yy)
  • Type of license (A, B or C)