Official SealSan Joaquin County Human Resources Division


#0217-RH5002-AC
Supplemental Questionnaire

Last Name
First Name
1.

The Radiologic Technologist II license and certificate minimum qualifications requires registration with the American Registry of Radiologic Technologists, and certification by the Department of Health, State of California, as a Radiologict Technologist.

Yes, I am registered with the American Registry of Technologist and certified by the Department of Health, State of California, as a Radiologic Technologist.
No, I do not meet the license and certification minimum qualifications.
2.

If you answered "yes" to question 1, please list the below information:

  1. Registration number with the American Registry of Radiologic Technologist, if any;
  2. Radiologic Technologist License/Certification number;
  3. Expiration date for #1 & #2

Note:  Licenses will be verified.

3.

The Radiologic Technologist minimum experience qualifications requires eighteen (18) months performing radiographic work.  Please describe your duties/responsibilities in performing radiographic work. When providing examples of your work experience, please reference the below information:

  • Job Title
  • Name of Employer
  • Dates of employment
  • Hours worked per week