Official SealSan Joaquin County Human Resources Division


#0723-RH1106-A3
Supplemental Questionnaire

Last Name
First Name
1

Do you possess a Bachelor's degree in Nursing, or related field?
Yes No
2

Do you possess National Certification? Please note: if yes, you must provide proof of certification with your employment application in order to be considered.
Yes No
3

Experience:

Do you possess at least two (2) years of paid Registered Nurse experience in an Operating Room, one year of which can be considered equivalent to San Joaquin County's journey level Staff Nurse IV-Inpatient classification?
Yes No
4

Licenses and Certificates:

In order to qualify to work in the Operating Room, you must have successfully completed the Hemodynamic Monitoring Class, Preceptor Class and ACLS certification. Note: Proof of completion must be submitted with your employment application in order to be considered.

Please check all that apply below:
Yes, I have completed the approved Hemodyamic Monitoring Class
Yes, I have completed an approved Preceptor class (or adult training equivalent)
Yes, I currently have ACLS Certification
I have not completed any of the above mentioned courses/certification
 

Are you currently licensed as a Registered Nurse with the State of California?
Yes No
5

San Joaquin General Hospital is a 24/7 running facility.  Employees are expected to be open to working rotating shifts that will include nights, weekends and holidays.  Are you available to work in a position that has these requirements?
Yes No