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Supplemental Questionnaire

Last Name
First Name


Submit responses to the following questions with your employment application to the San Joaquin County Human Resources Division. Please provide a detailed description of your work experience. These questions will be reviewed in evaluating your qualifications.

Do you possess a Master’s Degree in nursing which meets the State of California Clinical Nurse Specialist requirements?
Yes No

Do you possess at least 2 years of full time experience as a registered nurse in an acute care facility's Neonatal Intensive Care Unit?

Yes No
Please provide your Clinical Nurse Specialist Certification number as issued by the State of California:

This position requires a license as a Registered Nurse issued by the State of California Board of Registered Nursing.  Provide your license number and expiration date.

Do you possess a valid California Driver's License?
Yes No