Official SealSan Joaquin County Human Resources Division


#0618-RH5353-AC
Supplemental Questionnaire

Last Name
First Name
1

Do you possess at least one year of full-time (40 hours per week/2080 hours) paid experience as a licensed respiratory care practitioner in an acute care hospital? 
Yes No
1a

Please indicate if your experience was gained from one of the following:
Long Term Acute Care (LTAC)
Skill Nursing Facility (SNF)
Other
1b

Please indicate if you possess experience in the following:
Intubating infants
Intubating adults
Transporting critically ill babies
All of the above
None of the above
1c

If yes, please provide the following information:

  • A description of the specific duties performed as a licensed respiratory care practitioner in an acute care hospital
  • Your experience intubating critically ill babies or adults, if any
  • Dates of employment
  • Number of hours worked per week
2

Do you possess a valid Respiratory Care Practitioner license issued by the State of California Respiratory Care Board?

A copy of the license must be submitted with the employment application.  Or, a copy may be sent to msneed@sjgh.org or faxed to 209-468-6271.
Yes No
3

By clicking on the box, I acknowledge and accept that an offer of employment as a Respiratory Care Practitioner II is conditional on my ability to provide proof of a high school diploma or equivalent as required by the California Association of Pathology for non-waive testing.
4

Position(s) may rotate or be assigned to the Medical Guarded Unit. As a condition of employment, candidates assigned to the Medical Guarded Unit must successfully pass a California Department of Corrections (CDCR) background investigation conducted by the California Depatment of Corrections and Rehabilitation. Candidates must also maintain their CDCR clearance for continued employment in this unit. Please check the below box to acknowledge you understand and will comply with the above terms.
Yes, I acknowledge and understand the above terms.
5

This referral pool may be used to fill future Respiratory Care Practitioner II part-time premium and per diem vacancies. Please select from the following referral opportunities below:

Note: You will only be referred if you select yes to either of the options listed.
Yes, I would like to be considered for referral for future Respiratory Care Practitioner II part-time premium vacancies.
Yes, I would like to be considered for referral for future Respiratory Care Practitioner II per diem vacancies.
No, I am not interested in being referred for future Respiratory Care Practitioner II part-time premium or per diem vacancies.