Official SealSan Joaquin County Human Resources Division


#1122-RH1103-FL
Supplemental Questionnaire

Last Name
First Name
1.

Do you have a Bachelor's Degree in Nursing or a related field?
Yes No

 

Please ensure this is CLEARLY indicated in the Education section of your application.
2.

Do you have at least 6 months of RN experience in an acute care hospital or mental health facility?
Yes No
3.

Please select the level of your Cardiology/Cardiac Catheter Laboratory experience equivalent to Staff Nurse III from the options below:
Less than one year
More than one year
More than two years

 

If yes, please ensure this is CLEARLY demonstrated in the Employment Experience section of the application. 
4.

Are you currently registered as a nurse in the State of California?
Yes No

 

Please ensure this is CLEARLY indicated in the Professional Licenses, Certifications, or Registrations section of your application. 
5.

Please select all of the certifications you currently hold from the list below and include copies with your application:
ACLS
EKG
Preceptor
National Certification