Official SealSan Joaquin County Human Resources Division


#0718-RO4130-TM
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess two years experience performing medical staff credentialing functions or providing administrative clerical support to medical and/or management staff in a health care environment, preferably in an acute care hospital, health maintenance organization or managed care facility?
Yes No
 

If you answered yes to the previous question, please specify your experience including the following:

  • Job title
  • Name of facility/business
  • Dates of employment
2.

Are you substituting a valid Certified Provider Credentialing Specialist certificate issued by the National Association of Medical Staff Services (NAMSS) for the required experience?

If so, please provide a copy of your certificate with your employment application by attaching a pdf file in the "resume" section of this application.
Yes No
3.
Are you substituting an associate’s degree in business administration or related field for one year of the required experience?
Yes No
4.

If yes, please identify:

  • School/Institution attended
  • Degree achieved / Area of study