Official SealSan Joaquin County Human Resources Division


#0919-RS9215-AC
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.

Do you possess current certification as a Lactation Consultant by the International Board of Lactation Consultant Examiners?

Yes No
 

If you answered Yes, please provide your certification number and expiration date.  A copy of your IBCLC certification must also submitted with your application.

2.

Please describe any experience you may have in providing breastfeeding and/or WIC-related or healthcare services.

3.

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