Official SealSan Joaquin County Human Resources Division


#0117-RH3031-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess at least one (1) year of paid work experience as an Operating Room Technician I in San Joaquin County?
Yes No
2.

Do you possess at least one (1) year of paid work experience as a surgical or operating room technician in an acute care hospital within the past five (5) years?
Yes No
 

Please describe in detail your experience working as an operating room or sugical technician for an acute care hospital. If you do not possess experience, please note "N/A" below:
3.

Have you successfully completed an approved Operating Room/Surgical Technician training or program? (NOTE: Must provide proof of successful completion with employment application in order to be considered)
Yes No
 

If Yes, please provide the following: Name of Institution, name of certification received,  and the date of your program completion:
4.

Operating Room Technicians are required to be available in Stand-By status as part of a rotation, and must be ready to start surgical cases within 30 minutes of notification. Do you acknowledge that you can meet this requirement?
Yes No
5.

This recruitment is being conducted to fill full-time positions and may be utlized to fill part-time positions. Please indicate below what employment type you would like to be considered for (Check mark all that applies):

I would like to be considered for Full-Time positions.
I would like to be considered for Part-Time positions.