Official SealSan Joaquin County Human Resources Division


#0419-RS4110-01
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you have a bachelor's degree from an accredited college or university in biological sciences, health science, public health, behavioral sciences, or a related field?

Yes No
 

If yes, please provide the following information:

  • Name of accredited college or university from which you obtained your degree
  • Degree conferred
  • Major
2.

PATTERN II

Do you have 60 semester or 90 quarter units from an accredited college or university with major coursework in biological sciences, behavioral sciences, health education, health science, public health, nursing, or a closely related field?

Yes No
 

If yes, please provide the following:

  • Course title
  • Number of units completed for each course (specify if semester or quarter units)
 

In addition to the completion of units listed above, to qualify under this pattern you must have two years of full-time paid experience working in a public health department or community based or medical organization in the provision of community based health services such as communicable diesease investigation, treatment and control, health education, counseling, interviewing, or a closely related field.

In the space provided below, please describe your experience in this area and include the name of your employer, job title, dates of employment, a description of duties performed, and indicate if experience was full- or part-time and the number of hours worked per week.

3.

This position requires possession of a valid California driver's license.  Please provide your license number and expiration date.


 

Upon employment with San Joaquin County, incumbents for this position may be required to successfully complete one or more of the following depending upon the nature of the assignment: 1) a state approved phlebotomy course; 2) TB testing, HIV/AIDS counseling, and/or sexually transmitted disease certification.