Official SealSan Joaquin County Human Resources Division


#0319-RH5353-TM
Supplemental Questionnaire

Last Name
First Name
1

Do you possess at least one year of full-time (40 hours per week/2080 hours) paid experience as a licensed respiratory care practitioner?

Yes No
1a

Please indicate if your experience was gained from one of the following institutions:

Acute care hospital
Long Term Acute Care (LTAC)
Skill Nursing Facility (SNF)
Other
1b

Please indicate if you possess experience performing the following duties (select all that apply):

Intubating infants
Intubating adults
Transporting critically ill babies
All of the above
None of the above
1c

Please provide the following information regarding your respiratory care practitioner experience:

  • Job Title
  • Employer
  • Dates of employment
  • Number of hours worked per week
  • Specific job duties performed
  • Your experience intubating critically ill babies or adults, if any
2

Please provide your Respiratory Care Practitioner license number. (Write "none" if you do not possess a valid California Respiratory Care Practitioner license.)

3

By clicking on the box, I acknowledge and accept that an offer of employment as a Respiratory Care Practitioner II is conditional on my ability to provide proof of a high school diploma or equivalent as required by the California Association of Pathology for non-waive testing.

4

Position(s) may rotate or be assigned to the Medical Guarded Unit. As a condition of employment, candidates assigned to the Medical Guarded Unit 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 this unit. Please check the below box to acknowledge you understand and will comply with the above terms.

I acknowledge and understand the above terms and conditions of employment.
5

The San Joaquin General Hospital (SJGH) Nursing Division is committed to providing the highest quality of care to the patients they serve. In order to follow this commitment, staff are expected to:

  • be at their work station at the start of their shift and ready to work
  • maintain professional behavior in the workplace
  • adhere to professional dress appearance
  • follow San Joaquin County Health Services, including San Joaquin General Hospital, policies
  • practice Service Excellence
  • provide adequate hours to orient to Health Care Services, San Joaquin General Hospital, the Nursing Division, and assigned unit

By clicking on the box, I acknowledge and understand that I will adhere to these expectations.