Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name

You must be at least 18 years of age; and you must submit to and pass an FBI and Department of Justice fingerprinting background check. Do you acknowledge and accept these terms?

Yes No

This position requires six months of paid or volunteer experience as a program leader, counselor, teacher, or assistant working with groups in an educational, recreational, cultural or other social program.  Please describe in detail six months work experience including name of employer, hours worked per week, job title and specific duties.  If paid experience please include salary.


NOTE: Volunteer hours will be accepted only if: 1) The volunteer experience is documented on letterhead from the organization where it was obtained; 2) The documentation includes dates, numbers of hours worked and duties performed; and 3) The experience was obtained within the last 10 years.  If you are qualifying under this experience have you included this required documentation.

Yes No

The substitution for the required experience is completion of 30 semester units at an accredited college or university, including at least six semester units in the social or behavioral sciences.  Please list number of units completed and the six semseter unit of social or behavioral sciences.  List the course names of the six social or behavioral units.