Official SealSan Joaquin County Human Resources Division


#0418-RH1103-AC
Supplemental Questionnaire

Last Name
First Name

 

A copy of the RN license or Interim Permit must be submitted with the completed employment application.  It can be uploaded when prompted to add a resume.  Or, it can be submitted via email to humanresources@sjgov.org or by fax to (209) 468-6271. 

Please note that when selecting the inpatient units of interest, vacancies in the units may not be currently available although effort is made to hire candidates into their primary department of interest. 


1

Please indicate if you possess one of the following:

Registered Nurse License as issued by the State of California Board of Registered Nurses
Interim Permit as issued by the State of California Board of Registered Nurses
None of the above
1a

Please provide your California RN license or Interim Permit number.

2

Do you possess 6 months of full-time (40 hours per week/1040 hours) paid experience as a registered nurse in an acute care or mental health facility? (Please note that nursing experience at a Skilled Nursing Facility is not recognized as acute care)

Yes No
3

Substitution:

Possession of a Bachelor's Degree in Nursing may be substituted for the required 6 months experience. Do you possess a Bachelor's Degree in Nursing?

Note: If yes, please be sure to clearly reflect that information on your employment application in the "education" section.

Yes No
4

Please select from the following list of inpatient units for which you are interested in being referred for hiring consideration:

Cardiac Cath Lab / EKG
Emergency Department
Float Pool Unit*
Hemodialysis
Intensive Care Nursery
Intensive Care Unit
Labor-Delivery-Recovery-Post Partum
Medical-Surgical Unit*
Medical Guarded Unit (MGU)*
Pediatrics
Post-Anesthesia Care Unit (PACU)
Progressive Care Unit (PCU)
Surgery Recovery**
All of the above
Other
5

*Medical Guarded Unit: Positions in this unit provide healthcare services to an inmate population. As a condition of employment, candidates must successfully pass a background investigation conducted by the California Department of Corrections and Rehabilitation (CDCR). Candidates must also maintain the CDCR clearance for continued employment in the Special Care Unit or Medical Garded Inpatient unit.

Check a box below to acknowledge the terms listed above.

Yes, I acknowledge and understand the terms and conditions identified above.
I am not interested in being referred to the Medical Guarded Unit.
6

**Note:  If Surgery-Recovery has been selected as a unit of interest, positions in this unit must be able to report to work within 30 minutes of call back.

Yes, I acknowledge the term and condition of employment listed above.
I am not interested in being referred to the Surgery-Recovery unit.
7

CERTIFICATIONS:

Please select from the list below for which you currently possess active certifications (check all that apply):

ACLS
BLS
CCRN (Critical Care Registered Nurse)
Chemotherapy
CPR
EKG or course completion
PALS
None of the above
Other (identify in the application)
8

As a 24-7 facility, San Joaquin General Hospital employees may be asked to be available to work any shift.

Listed below are various examples of work shifts. Please identify your availability:

7:00 am to 7:00 pm
7:00 pm to 7:30 am
7:00 am to 3:30 pm
3:00 pm to 11:30 pm
11:00 pm to 7:30 am

 

This recruitment will be utilized to fill full-time, part-time, and per diem positions. Please ensure to mark the first page of your employment application with your desired employment status interest (select all that are applicable). If this changes at any time, you can contact Human Resources at (209) 468-6918 to update your interest. (see example screen shot below):

 Type of employment you are willing to accept:   Full-Time Part-Time Temporary Contract Per Diem (Health Care Services Only)