Official SealSan Joaquin County Human Resources Division


#0119-RH1815-01
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


1.

This position requires a vaild license as a Registered Nurse issued by the State of California Board of Registered Nursing.  Provide your license number and expiration date.

2.

This position requires a valid Public Health Nurse certificate issued by the State of California Board of Registered Nursing.  Provide your license number and expiration date.

3.

Please describe your post-bachelor degree nursing experience which included at least three years of community-based nursing in a community health, public school, county public health, or comaprable setting that included work in areas such as communicable disease response/prevention, health education, public health emergency planning, or community-based nursing case management.

4.

This position will be assigned to the Communicable Disease/Tuberculosis program.  Please describe any public health nursing experience you may have in a communicable disease/tuberculosis program.

5.

This position will be a first-line supervisor.  Please describe any experience you may have in the supervision of employees.