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Supplemental Questionnaire

Last Name
First Name
 

LICENSE AND CERTIFICATION

Please provide your current license number as a Speech Pathologist issued by the California Speech-Language Pathology and Audiology and Hearing Aid Dispensers’ Board.

 

Please provide your certificate or account number for your Certificate of Clinical Competency in Speech Pathology issued by the American Speech-Language-Hearing Association(ASHA):

 

COUNTY SERVICE

If you currently work or have worked for San Joaquin County in the past, please provide your employee ID number:

Note: To avoid delays in the application review process, please ensure that you provide your full work history and tasks performed under the Employment Experience tab. If you are not a current employee or have not worked for San Joaquin County, please type "N/A".

 

WORK EXPERIENCE

Please indicate the amount of progressively responsible experience as a licensed speech pathologist performing diagnostic and therapeutic speech pathology techniques for a variety of disabling conditions.

Note: To avoid delays in the application review process, please ensure that you provide your full work history and tasks performed under the Employment Experience tab. 

At least two (2) years, but less than three (3)
At least three (3) years, but less than four (4)
More than four (4) years
Less than two (2) years
 

SPEECH THERAPIST IV - CLINICAL SPEC

SPECIAL REQUIREMENT: 

Applicants must possess certificates of completion for at least three courses in an area of clinical specialty as approved by the Department of Health Care Services or San Joaquin General Hospital.

Please indicate the three courses of clinical specialty completed, where they were obtained below:

 

SUBSTITUTION

Satisfactory completion of a Clinical Fellowship Year from the American Speech-Language-Hearing Association while employed at San Joaquin General Hospital may be substituted for one year of the required experience.

If this applies to you, please provide the year of completion below.  In addition, please attach proof of completion to your application or email it to rocastro@sjgov.org.