Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name

Have you completed 60 semester (or 90 quarter) units from an accredited college or university with course work in military science, business or public administration, psychology, health science, social science or a related field?

Yes No

If you answered yes, please list the following:

Name of institution


Total number of units completed 


Do you have one year of experience in the following areas: clerical or administrative support experience in a county veterans service office, a veterans service contact office, or a Veterans Administration regional office?

Yes No

If you answered yes, provide employer, dates of employment, job title, specific job duties, and the number of paid hours worked per week:


Do you have one year of technical administrative experience in government, military, or in fields similar to health care or social services, disability insurance claims, or social security that included interviewing or obtaining information from clients to determine their eligibility for services or program benefits, as well as researching and explaining policies, laws, and/or regulations?

Yes No

If you answered yes, provide employer, dates of employment, job title, specific job duties, and the number of paid hours worked per week:


Do you have lived experience applying for a variety of veteran-specific benefits as a veteran or active duty service member with relevant experience and knowledge of military/Veterans Administration?

Yes No

Please provide details of qualifying experience below:



Additional qualifying experience may be substituted for the required education on a year-for-year basis where one year of experience is considered equivalent to 30 semester (or 45 quarter) college units.  Do you wish to use this substitution?

Yes No
Do you possess a valid California driver's license?
Yes No

If yes, please provide your California driver’s license number and expiration date.