Official SealSan Joaquin County Human Resources Division


#0818-RH1124-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a Bachelor's Degree in Nursing, Health Science or closely related field?  If yes, identify degree type, name of school in which the degree was obtained and your graduation date.

2.

Describe your registered nurse experience in an acute care hospital. Identify the name of your employer, position title, duties, timeline of employment and average hours worked per week.

3.

Do you possess a current RN license issued by the State of California? If yes, identify the license number and expiration date.

4.

Do you possess experience as a Clinical Documentation Specialist? If yes, identify your employer, position title, time of employment and job duties.

5.

Do you possess credentialing as a Certified Clinical Documentation Specialist? If yes, identify the credentialing number and date of expiration.