You are applying for a position in Correctional Health Services, which provides health care to adult inmates at the San Joaquin County jail facility.
A candidate must successfully pass the security clearance, initiated through a background investigation conducted by the Sheriff’s Office. The background investigation requires the completion of an extensive questionnaire called “Personal History Questionnaire” and is used by the Sheriff’s Office to conduct the background investigation.
The security clearance is a mandatory condition of employment, and the loss of the security clearance will result in termination from County employment in accordance with the rules and regulations governing County employment.
1.
Have you read the above information and understand that passing and maintaining a security clearance is a condition of employment?
Yes
No
2.
Have you previously had a security clearance in a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of employer and dates of employment.
3.
Have you failed a security clearance in the past for a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of employer and date you failed the security clearance.
4.
Have you ever had a security clearance revoked while employed in a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of the employer and the reason your security clearance was revoked.
5.
Are you willing to work with adult inmates who are incarcerated?
Yes
No
6.
Employment history is part of the background investigation process. Have you ever been terminated from a job or resigned from a job to avoid termination (not including involuntary layoff)?
Yes
No
If you answered yes, provide the name of employer and date of separation
7.
I understand that a thorough background investigation will be conducted as part of the selection process. I hereby certify that I have personally completed each question and that all statements are true and complete. I understand that any omissions or misstatements of facts may be considered deliberate falsification on my part, which will subject me to disqualification or, if discovered after my employment, to termination in accordance with County rules and regulations.
Yes
No
8.
I understand that if I successfully pass the background investigation and obtain the security clearance, I will be expected to maintain my security clearance as a condition of my employment and failure to do so will result in the termination of my employment with the County in accordance with County rules and regulations.
Yes
No
9.
If Per Diem positions become available, would you be interested in being referred?
Defintion of Per Diem: Non-Benefited Staff Nurse positions. Employees in this status shall receive supplemental pay (20%) in lieu of benefits. Per Diem nurses work as needed.
Yes
No
10.
Are you currently registered as a nurse with the State of California Board of Registered Nursing?
Yes
No
Please provide your RN license Number:
11.
Experience: Do you currently have 6 months of experience as a registered nurse in an acute care or mental health facility? If so, please provide details regarding employment. Include the following information: employer name, employment dates, hours worked, and duties performed.
12.
Substitution:
Do you currently possess a Bachelor's Degree in Nursing? If so, please provide details of school attended.
San Joaquin County Human Resources Division