You are applying for a position in Correctional Health Services, which provides health care to adult inmates at the San Joaquin County jail facility.
A candidate must successfully pass the security clearance, initiated through a background investigation conducted by the Sheriff’s Office. The background investigation requires the completion of an extensive questionnaire called “Personal History Questionnaire” and is used by the Sheriff’s Office to conduct the background investigation.
The security clearance is a mandatory condition of employment, and the loss of the security clearance will result in termination from County employment in accordance with the rules and regulations governing County employment.
1
Have you read the above information and understand that passing and maintaining a security clearance is a condition of employment?
Yes
No
2
Are you willing to submit to a background investigation conducted by the Sheriff’s Office?
Yes
No
3
Have you previously had a security clearance in a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of employer and dates of employment.
4
Have you failed a security clearance in the past for a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of employer and date you failed the security clearance.
5
Have you ever had a security clearance revoked while employed in a detention facility or law enforcement agency?
Yes
No
If you answered yes, provide the name of the employer and the reason your security clearance was revoked.
6
Are you willing to work with adult inmates who are incarcerated?
Yes
No
7
Employment history is part of the background investigation process. Have you ever been terminated from a job or resigned from a job to avoid termination (not including involuntary layoff)?
Yes
No
If you answered yes, provide the name of employer and date of separation
8
I understand that a thorough background investigation will be conducted as part of the selection process. I hereby certify that I have personally completed each question and that all statements are true and complete. I understand that any omissions or misstatements of facts may be considered deliberate falsification on my part, which will subject me to disqualification or, if discovered after my employment, to termination in accordance with County rules and regulations.
Yes
No
9
I understand that if I successfully pass the background investigation and obtain the security clearance, I will be expected to maintain my security clearance as a condition of my employment and failure to do so will result in the termination of my employment with the County in accordance with County rules and regulations.
Yes
No
10
If Per Diem positions become available, would you be interested in being referred?
Defintion of Per Diem: Non-Benefited Staff Nurse positions. Employees in this status shall receive supplemental pay (20%) in lieu of benefits. Per Diem nurses work as needed.
Yes
No
11
Are you currently registered as a nurse or possess an interim permit issued by the State of California Board of Registered Nursing?
Yes
No
12
Please provide your RN or interim permit license number.
13
Do you possess a current CPR certificate? (submit a copy of your CPR certificate to Human Resources)
Yes
No
In order to ensure your nursing experience meets the qualifications required as a Staff Nurse III – Inpatient in San Joaquin County Correctional Health Services, please read the following paragraphs on what is considered “acute care (hospital) setting ” before answering the questions on whether you have the required one year of experience as a registered nurse in an acute care setting at a level equivalent to San Joaquin county Staff Nurse III-Inpatient.
Acute care is a level of care where patients are treated for a brief acute episode of illness, for conditions that are the results of a disease or trauma, and during recovery from surgery. Acute care is generally only provided in hospitals where all of the following medical units/services are provided:
Emergency
Medical Surgical
Labor and Delivery
Intensive Care Unit
Nurses who work in a health care facility that primarily provides care for chronic health conditions or sub-acute care, or is a skills nursing facility (SNf) do not meet the definition of “acute care setting” for the purpose of meeting the minimum qualifications of Staff Nurse III - Inpatient in Correctional Health Services.
14. Do you have at least six months of experience as a registered nurse in an acute care (hospital) setting?
Yes
No
If yes, please provide the following information for each employer where you were employed as a registered nurse in an acute care (hospital) setting.
Employer #1
Name of the hospital: ___________________________________
Dates of employment: ___________________________________
Hours of work per week: ____________________________________
Does this hospital have the following medical units/services?
A. ER
Yes
No
If yes, did you work in this unit?
Yes
No
B. Medical Surgical
Yes
No
If yes, did you work in this unit?
Yes
No
How many patient beds are in the Medical Surgical unit?
C. Labor and Delivery (Maternity)
Yes
No
If yes, did you work in this unit?
Yes
No
D. Intensive Care Unit
Yes
No
If yes, did you work in this unit?
Yes
No
Employer #2
Name of the hospital: ___________________________________
Dates of employment: ___________________________________
Hours of work per week: ____________________________________
Does this hospital have the following medical units/services?
A. ER
Yes
No
If yes, did you work in this unit?
Yes
No
B. Medical Surgical
Yes
No
If yes, did you work in this unit?
Yes
No
How many patient beds are in the Medical Surgical unit?
C. Labor and Delivery (Maternity)
Yes
No
If yes, did you work in this unit?
Yes
No
D. Intensive Care Unit
Yes
No
If yes, did you work in this unit?
Yes
No
15.
Do you acknowledge that you are available to work every other weekend and on an as needed basis.