Official SealSan Joaquin County Human Resources Division


#0319-RH1320-01
Supplemental Questionnaire

Last Name
First Name

 

Please provide responses to the following questions.  This supplemental questionnaire is an extension of your employment application and will be reviwed to thoroughly assess your qualifications.  Resumes are not accepted in lieu of completing this questionnaire.

When responding to questions relating to your work experience, please provide a detailed description that includes the name of your employer, dates of employment (beginning and end dates), job title, number of hours worked per week, and indicate if experience was paid or unpaid.


1.

Please describe your experience in a clinical quality management program.  Identify the scope of the program, your role in the process, and experience in planning, developing, implementing, directing, and evaluating quality improvement programs and policies.  If you do not possess this experience, please note "N/A".

2.

Please describe any experience you possess in the area of process/performance improvements and dvelopment of practices and/or principles related to system-wide quality outcomes that comply with accreditation and certification standards.

3.

Please describe your experience in working to improve patient satisfaction ratings and working with nursing administration to improve or maintain excellent patient service.

4.

Please describe all of your fill-time paid RN clinical and supervisory/charge nurse experience in an acute care hospital or mental health facility.  Include the size of the hospital and/or mental health facility.

5.

Do you possess a bachelor's degree in Nursing, Health Science, Business Administration or other closely related field?

Yes No

 

Note:  Possession of this degree may be substituted for one year of the required non-supervisory experience.  If you answered Yes, please be sure your degree information is clearly identified in the education section of your employment application.


6.

Current registration as a Nurse in the State of California is required.  Please provide your California RN license number and expiration date.  This information will be source verified with the California Board of Registered Nursing.

7.

Please indicate if you possess or have completed any National certifications. ( Please describe in the section below and provide copies with your application.)