Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name
Do you possess 60 semester units or 90 quarter units in an accredited college or university with a major in electronics or a related area?
Yes No

If you answered Yes to Question 1, please provide:

  • Name of college or university
  • Major area of study
  • Name of courses completed and number of units per course (indicate type of unit, semester/quarter)

    If you answered No to Question 1, indicate "n/a" below.

Have you completed an advanced military electronics school?

If you indicate yes, a copy of proof of completion must be submitted online with your employment application at the time of filing or e-mailed/mailed to Human Resources by the final filing deadline.

Yes No

If you answered Yes to Question 3, please provide:

  • Name of the advanced military electronics school
  • Name of program study area
  • Description of area of study
  • Date of completion 

    If you answered no to question 3, indicate "n/a" below.

Do you have at least one (1) year (equivalent to 2,080 hours) of paid experience in the repair, maintenance or modificiation of medical equipment?

Yes No

If you answered Yes to Question 5, please provide:

  • Name of employer
  • Job title
  • Dates of employment
  • Number of hours worked per week
  • Detailed description of specific duties performed

    If you answered No to Question 5, please indicate "n/a" below.

List the types of complex medical equipment you have worked with and describe your experience performing repairs, adjustments, tests, and/or maintenance of these complex medical equipments. 


Do you possess experience in the repair, maintenance and modification of hospital ventilator equipment?

Yes No

Please check mark all of the boxes that apply.  I possess the following certificate(s) from the Association for Advancement of Medical Instrumentation (AAMI).

Certified Biomedical Equipment Technician (CBET)
Certified Laboratory Equipment Specialist (CLES)
Certified Radiology Equipment (CRES)
None of the above