Official SealSan Joaquin County Human Resources Division


#1122-RH1104-AC
Supplemental Questionnaire

Last Name
First Name

 

For those applying for Staff Nurse IV, a determination will be made as to which of the inpatient units you may be qualified based upon the certifications, licenses, and experience listed in the application. Each unit requires specific experience, licenses, and certificates as identified in the San Joaquin County CNA Career Ladder. Effort is made to hire candidates into their primary department of interest and preferred shifts.


 

Do you possess a current registration as a nurse in the State of California?

Yes No
 

Do you possess a BSN or MSN?

If yes, please be sure to complete the education portion of the application in as much detail as possible. Incomplete information can result in delays of the application process.

Bachelor's of Science in Nursing
Master's of Science in Nursing
None of the Above
 

Please check the box(es) for all departments in which you have at least 1 full year (2,080 hours) of acute care registered nursing experience.  

Cardiac Cath Lab/EKG
Case Management
Emergency Room
Float Pool Unit
GI/Short Stay Surgery
Hemodialysis
Intensive Care Unit
Labor-Delivery-Recovery-Post Partum
Medical Surgical Unit
Neonatal Intensive Care Unit (NICU/ICN)
Post-Anesthesia Care Unit (PACU)
Progressive Care Unit (PCU)
Surgery
Other
 

Please check the box(es) for all departments in which you may have interest in being referred. Referral will be based on career ladder qualifications.  

Cardiac Cath Lab/EKG
Case Management
Emergency Room
Float Pool Unit
GI/Short Stay Surgery
Hemodialysis
Intensive Care Unit
Labor-Delivery-Recovery-Post Partum
Medical Surgical Unit
Neonatal Intensive Care Unit (NICU/ICN)
Post-Anesthesia Care Unit (PACU)
Progressive Care Unit (PCU)
Surgery
Other
 

Please check the box(es) for all certifications that you currently possess. Please upload copies of all certifications when prompted to upload a resume.

National Nursing Certification
Advanced Cardiac Life Support (ACLS)
MICN-Code 3 Clearance
Preceptor
Critical Care Class
Chemotherapy Certification
Hemodynamic Monitoring Class
Pediatric Advanced Life Support (PALS)
Fluid and Electrolyte Class
Renal Failure Class
EKG Class
Physical Medicine and Rehabilitation (PM&R)
Peripherally Inserted Central Catheter (PICC)
Neonatal Resuscitation Program (NRP)
ED Essentials
Fetal Heart Monitoring
Advanced Fetal Heart Monitoring
ICN Class
MSE Triage