Official SealSan Joaquin County Human Resources Division


#0324-RH6000-FL
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


1.

This Occupational Therapy series of positions requires you to possess and maintain a current license as an Occupational Therapist Assistant or Occupational Therapist issued by the California Board of Occupational Therapy.  Do you possess either of these licenses?

Yes No
 

If you answered Yes to the previous question, provide your current Occupational Therapist Assistant or Occupational Therapist license number issued by the California Board of Occupational Therapy, and the expiration date.

Note:  This information will be source verified.

2.

Occupational Therapist Senior

Qualification for the Occupational Therapist Senior requires the Occupational Therapist license issued by the California Board of Occupational Therapy and either of the following 2 patterns:

One year of experience as an Occupational Therapist in San Joaquin County.

OR

Two years of progressively responsible experience as a licensed occupational therapist performing diagnostic and/or therapeutic occupational therapy techniques for a variety of disabling conditions.

If applying for the Occupational Therapist Senior, do you posses these qualifications?

Yes No
 

If you answered Yes, please describe your work experience and include the following information and indicate if the experience was paid, volunteer, or intern:

  • Name of employer
  • Employment dates
  • Number of hours worked per week
  • Specific job duties performed

Note:  To qualify under this experience pattern, you must complete this section.  A resume is not accepted in lieu of completing, or as a response to, this question.  Providing all information requested will assist in assessing your qualifications.

4.

Possession of a valid California driver's license may be required by the nature of the assignment.  Please provide your driver's license number and expiration date.