Official SealSan Joaquin County Human Resources Division


#0922-RH1811-01
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.

This position requires a valid license as a Registered Nurse issued by the State of California Board of Registered Nursing.  Provide your license number and expiration date.

2.

Do you possess a valid California Public Health Nursing Certificate?

Yes No
 

If you answered Yes, please provide your Public Health Nursing Certificate number and expiration date.

3.

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