Official SealSan Joaquin County Human Resources Division


#0618-RH1235-01
Supplemental Questionnaire

Last Name
First Name
1.

This position requires an active license as a Registered Nurse in the state of California. Do you currently possess an active license as a Registered Nurse in the State of California?
Yes No
 

If yes, please provide the license number and expiration date.
2.

This position requires that you possess a minimum of (3) three years progressively responsible experience as a registered nurse in an accredited acute care hospital.

A bachelors degree in nursing may substitute for one year of the experience. Do you possess a Bachelors Degree in Nursing?
Yes No
2a.

If yes, please identify the name of the College/University from which the degree was obtained
2b.

Please describe your progressively responsible experience as a registered nurse in an accredited acute care hospital. Please identify:

  • the employer(s), job title(s), dates of employment, and duties performed