Official SealSan Joaquin County Human Resources Division


#0518-RH0853-01
Supplemental Questionnaire

Last Name
First Name
1

This is a departmental promotional recruitment. Qualified applicants must be currently employed with San Joaquin General Hospital and meet the promotional eligibility requirements as stated in Civil Service Rule 10, Section 3 - Eligibility for Promotional Examinations.

Are you currently employed by San Joaquin General Hospital?

Yes No
2

Do you possess at least two (2) years of full-time paid experience as a sterile processing technician which included the following: 

  • cleaning
  • decontaminating
  • inspecting
  • packing and sterilizing surgical instruments and medical devices
Yes No
2a

If you responded yes, please select the facility for which you were employed as a sterile processing technician.

acute care hospital
medical facility
other
none of the above
2b

Briefly describe the specific sterile processing duties performed.

Please note that at least one year of the required experience must be at a journey level.  A journey level candidate is full trained and qualified in the duties to be performed.

3

Please indicate if you possess at least one of the following certifications (check all that apply):

A copy of the certificate must be submitted with the employment application to be considered.  The certificate may be submitted by uploading to the application when prompted for a resume, by email to msneed@sjgh.org, or by fax to (209) 468-6271.

I am currently certified in sterile processing techniques by the CBSPD.
I am currently certified in sterile processing techniques by the IAHCSMM.
I do not currently possess a certificate in sterile processing techniques by either of the agencies listed.
3a

If you currently possess certification with CBSPD or IAHCSMM, provide your certification number and expiration date below:

4

Please note that this position is a working supervisor class and requires that an incumbent performs the following duties: 

  • lifting 30 pounds or less
  • pushing case carts weighing up to 100 pounds
  • working in stressful/emergency situations
  • working rotating shifts, including nights, weekends, holidays, and overtime
  • frequent holding, grasping, repetitive motion

Please indicate that you are able to perform these duties.

Yes No