Official SealSan Joaquin County Human Resources Division


#0424-RH1240-AC
Supplemental Questionnaire

Last Name
First Name

 
Please complete the following supplemental questions for the position of Quality Improvement Coordinator at San Joaquin General Hospital.  This supplemental will be utilized to best determine your qualifications for this position.
1
Do you have three years of progressively responsible experience as a registered nurse in a hospital, health plan, or ambulatory clinic system, including one year of responsibility for quality improvement functions?
Yes No
2
Are you substituting the possession of a Bachelor's degree in Nursing, Health Science, or closely related field for one year of the required experience?  (If yes, please make sure that this is clearly identified on your application or resume)
Yes No
3
Are you substituting possession of a current Certified Professional in Healthcare Quality (CPHQ) certificate for one year of the required experience? (if yes, a copy of CPHQ certificate must be submitted with your application)
Yes No
4
Are you currently licensed as a Registered Nurse with the State of California?
Yes No
 
If yes, please provide your license number below: