San Joaquin County Human Resources Division
#0724-RH1104-AC
Supplemental Questionnaire
| Last Name | |
|---|---|
| First Name |
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For those applying for Staff Nurse IV, a determination will be made as to which of the inpatient units you may be qualified based upon the certifications, licenses, and experience listed in the application. Each unit requires specific experience, licenses, and certificates as identified in the San Joaquin County CNA Career Ladder. Effort is made to hire candidates into their primary department of interest and preferred shifts. |
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Do you possess a current registration as a nurse in the State of California? |
| Yes No |
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Do you possess a BSN or MSN? If yes, please be sure to complete the education portion of the application in as much detail as possible. Incomplete information can result in delays of the application process. |
| Bachelor's of Science in Nursing |
| Master's of Science in Nursing |
| None of the Above |
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Please check the box(es) for all departments in which you have at least 1 full year (2,080 hours) of acute care registered nursing experience. |
| Cardiac Cath Lab/EKG |
| Case Management |
| Emergency Room |
| Float Pool Unit |
| GI/Short Stay Surgery |
| Hemodialysis |
| Intensive Care Unit |
| Labor-Delivery-Recovery-Post Partum |
| Medical Surgical Unit |
| Neonatal Intensive Care Unit (NICU/ICN) |
| Post-Anesthesia Care Unit (PACU) |
| Progressive Care Unit (PCU) |
| Surgery |
| Other |
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Please check the box(es) for all departments in which you may have interest in being referred. Referral will be based on career ladder qualifications. |
| Cardiac Cath Lab/EKG |
| Case Management |
| Emergency Room |
| Float Pool Unit |
| GI/Short Stay Surgery |
| Hemodialysis |
| Intensive Care Unit |
| Labor-Delivery-Recovery-Post Partum |
| Medical Surgical Unit |
| Neonatal Intensive Care Unit (NICU/ICN) |
| Post-Anesthesia Care Unit (PACU) |
| Progressive Care Unit (PCU) |
| Surgery |
| Other |
|
Please check the box(es) for all certifications that you currently possess. Please upload copies of all certifications when prompted to upload a resume. |
| National Nursing Certification |
| Advanced Cardiac Life Support (ACLS) |
| MICN-Code 3 Clearance |
| Trauma Nurse Core Curriculum |
| Emergency Nurse Pediatric Course |
| Trauma Care After Resuscitation Course |
| Transport Nurse Advanced Trauma Course |
| Preceptor |
| Critical Care Class |
| Pediatric Advanced Life Support (PALS) |
| EKG Class |
| Physical Medicine and Rehabilitation (PM&R) |
| ED Essentials |
| ICN Class |
| MSE Triage |
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San Joaquin General Hospital is offering part-time break nurse positions for Staff Nurse IVs in multiple departments. Please select any of the following shifts that you may be interested in: |
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Part-Time 56 hours per pay period, 8 hour shifts, days 9am to 5pm |
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Part-Time 56 hours per pay period, 8 hour shifts, days 9pm to 5am |
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Part-Time 40 hours per pay period, 5 hour shifts, days 9am to 2pm |
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Part-Time 40 hours per pay period, 5 hour shifts, days 9pm to 2am |
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I am not interested in working break nurse shifts. |