Official SealSan Joaquin County Human Resources Division


#1122-RH0820-PC
Supplemental Questionnaire

Last Name
First Name
1.

Please indicate if you possess six (6) months of full-time (40 hours per week) paid experience equivalent to Nursing Assistant or Stock Clerk in an acute care hospital.
Yes No
2.

From the following, indicate the duties for which you were responsible for performing as a Nursing Assistant, Stock Clerk, or equivalent position in an acute care hospital. (Select all that apply)
Maintain and re-stock supplies
Assist in a central supply unit
Distribute medical equipment and supplies
Keep routine records and reports
Pick up and deliver a variety of materials to various locations
Check goods received against invoices
Maintain records of stock received and issued
None of the above
All of the above
3.

Provide the specific duties performed as a Nursing Assistant, Stock Clerk, or equivalent position in an acute care hospital. Include the following information:

  • Name of acute care hospital
  • Dates of employment (from/to)
  • Number of hours worked per week