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#0418-RS4001-01
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


1.

This is a Departmental Promotional recruitment.  Qualified applicants must currently be employed with a department of San Joaquin County Health Care Services Agency and meet the promotional eligibility requirements as stated in Civil Service Rule 10, Section 3 - Eligibility for Promotional Examinations.

Are you currently employed with a department of San Joaquin County Health Care Services Agency?

Yes No
 

If you answered Yes, please provide your employee ID number, current job title, and name of the department to which you are currently assigned.

2.

This position requires possession of a valid California driver's license.  Please provide your license number and expiration date.

3.

PATTERN I

To qualify for this pattern, you must possess a master's degree from an accredited college or university in one of the following areas.  If qualifying under this pattern, please check the box below that applies to your degree, and make sure your complete degree information is clearly identified in the employment section of your application.

Note:  A master's degree that has not been completed or conferred will not be accepted as qualifying.

Master's - Public Health (MPH)
Master's - Health Education
Master's - Community Health
Master's - Health Promotion
Master's - Nutrition
Master's - Social Science
Master's - Communication
Other (please identify below)
 

If you possess a master's degree in a discipline other than what is listed above, please provide that information below.

4.

PATTERN II

To qualify under this pattern, you must possess a bachelor's degree from an accredited college or university in one of the following areas:

  • Public Health
  • Health Education
  • Community Health
  • Health Promotion
  • Nutrition
  • Social Science
  • Communication
  • Other related field

Do you possess a bachelor's degree in one of the areas listed above?

Yes No
 

If you answered Yes, please provide the following information and make sure your degree information is clearly identified in the education section of your employment application:

  • Name of college or university from which you graduated
  • Degree obtained
  • Major

Note:  A bachelor's degree that has not been completed or conferred will not be accepted as qualifying.

4a.

To qualify under this pattern, you must also possess three (3) years of full-time paid experience assisting Public Health Educators and other professional staff in meeting the specified health education needs of various areas of the public health agency and preparing appropriate educaitonal materials.

Do you possess full-time paid work experience that meets this requirement?

Yes No
 

If you answered Yes, please describe your qualifying paid experience and include the following information:

  • Name of employer
  • Job title
  • Dates of employment
  • Number of hours worked per week
  • Specific job duties performed, including public health area(s) and educational materials you have prepared

Note:  A resume is not accepted in lieu of completing or as a response to this question.  Providing all requested information relative to your work experience will assist in assessing your qualifications under this pattern.