Official SealSan Joaquin County Human Resources Division


#0123-RH2001-01
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid license as a Vocational Nurse issued by the State of California, Board of Vocational Nurse and Psychiatric Technician Examiners?
Yes No
2.

Do you possess a valid Interim Permit issued by the State of California, Board of Vocational Nurse and Psychiatric Technician Examiners?
Yes No

 

Please ensure this is CLEARLY indicated in the Professional Licenses, Certifications, or Registrations section of your application.