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#0423-RH0250-01
Supplemental Questionnaire

Last Name
First Name
1.

This position requires you possess a bachelor’s degree from an accredited college or university with a major in health services administration, public administration, business administration, or a closely related field.

Please list the college you graduated from and the degree completed in the space provided below.

2.

This position requires three years progressively responsible experience in a supervisory, managerial or administrative capacity in an emergency medical services setting.

In the space provided below, list relevant experience in an emergency medical service setting.  Include name of employer, job title, dates of employment and relevant job duties in your response.

3.

Substitution: A master's degree in health services administration; public administration or business administration may be substituted for one year of the required experience. 

If using substitution pattern to substitute one year of the required experience, please provide details regarding master's degree earned and school attended. 

4.

Possession of a valid California Driver's License is required. Please provide license number and expiration below: