Official SealSan Joaquin County Human Resources Division


#1218-RH3200-TM
Supplemental Questionnaire

Last Name
First Name
1.

Have you successfully completed a Medical Assistant program of training in an approved college or business school?  Note:  A copy of completion of the training program must be submitted with employment application in order to be considered.  You may attach a copy of your certificate to your online application.

Yes No
1a.

If yes, please specify:

  • name of program/school:
  • date of program completion: 
  • date certificate/degree received:
2.

This recruitment will be utilized to fill vacancies within the hospital's Ambulatory Care Clinics. One of the clinics is the Special Care Clinic. This clinic provides patient care to an inmate patient population. Please indicate below if you want to be considered for referral to the Special Care Clinic. (Note: only those eligibles who mark an interest in Special Care will be referred to that unit)

Yes, I would like to considered for referrals to the Special Care Clinic.
No, I am not interested in being referred to the Special Care Clinic.
2a.

*NOTE: If you indicated interest in the Special Care Clinic:

Positions in the Special Care Clinic provide health care services to an inmate population.

As a condition of employment, candidates must successfully pass a California Department of Corrections (CDCR) background investigation conducted by the California Department of Corrections and Rehabilitation.  Candidates must also maintain their CDCR clearance for continued employment in the Special Care Clinic or Medical Guarded Inpatient Unit. Please check the below box to acknowledge you understand the above terms.

Yes, I acknowledge and understand the above terms.
I am not interested in being referred to the Special Care Clinic.
3.

This recruitment may be utilized to fill several part time and temporary Outpatient Clinic Assistant vacancies. 

Please indicate your preference of referral below:

Part time
Temporary
Please consider me for both part time and temporary positions.
4.

This recruitment may be utilized to fill Outpatient Clinic Assistant positions that must have the ability to work 10 hour shifts which may include weekends and evenings. 

Yes, I acknowledge and accept that the position may require 10 hour shifts which including weekends and evenings.
No, I'm unable to work 10 hour shifts which may include weekends and evenings.