Official SealSan Joaquin County Human Resources Division


#1022-RS2001-TM
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 completion of 45 semester units from an approved college or university, of which a minimum of 30 units must be in Psychology, Social Work, Nursing or related Social Science.


 

Have you completed 45 semester units from an approved college or university?

Yes No
 

Have you completed 30 semester units in Psychology, Social Work, Nursing or related Social Science?

Yes No
2.

List the name of the college(s) you attended, course titles and number of units received (indicate if semester or quarter units).  Note: This section must be completed.  If you possess a degree in one of the areas noted above, please provide the name of the college or university from which you graduated, degree obtained, and major.

3.

The PHF (Psychiatric Health Facility) is a 24-hour inpatient facility. If hired for this position, you must be able to work rotating shifts (days, nights, pm) including holidays.

Are you available to work rotating shifts?

Yes No
4.

Describe any experience you may have providing client services in a mental health department or social service area.