Official SealSan Joaquin County Human Resources Division


#0919-RH1103-01
Supplemental Questionnaire

Last Name
First Name
1.

Please indicate if you possess one of the following:
State of California Registered Nursing (RN) license
State of California Interim Permit as issued by the Board of Registered Nursing (BRN)
None of the above
 

Please provide your California RN license or Interim Permit number.
2.

Please provide the number of years of full-time (40 hours per week) paid RN experience in an acute care facility.

Please note: Acute care is a level of care where patients are treated for a brief acute episode of illness, for conditions that are the result of 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 
Less than 6 months
More than 6 months but less than 1 year
More than 1 year
I do not possess any RN experience in an acute care hospital
3.

A Bachelor's degree in Nursing (BSN) may substitute for the required 6 months of registered nurse experience for the Staff Nurse III.  To use this substitution pattern, please identify the college or university attended, and the degree awarded:
4.

As a 24-7 facility, San Joaquin General Hospital employees may be asked to be available to work any shift.

Listed below are various examples of work shifts. Please identify your availability:
7:00 am to 7:00 pm
7:00 pm to 7:30 am
7:00 am to 3:30 pm
3:00 pm to 11:30 pm
11:00 am to 7:30 am
5.

Please select from the following list of inpatient units for which you are interested in being referred for hiring consideration:
Emergency Department
Float Pool Unit
Hemodialysis
Intensive Care Nursery
Intensive Care Unit
Labor-Delivery-Recovery-Post Partum (LDRP)
Medical Surgical Unit
Medical Guarded Unit (MGU)
Post Anesthesia Care Unit (PACU)
Progressive Care Unit (PCU)
Surgery-Recovery
All of the above
Other
 

If "other" was selected, please identify the department(s) below.
6.

Note: Candidates hired in the following units must successfully pass a California Department of Corrections and Rehabilitation (CDCR) background investigation and must maintain their clearance for continued employment: Medical-Surgical, Medical Guarded Unit, Float Pool.

Please indicate that you have read and understand this condition of employment for the units identified.
I understand and agree with this condition of employment.
I am not interested in being referred to the listed departments.
7.

**Note: If Surgery-Recovery has been selected as a unit of interest, positions in this unit must be able to report to work within 30 minutes of call back.
Yes, I acknowledge the term and condition of employment listed above.
I am not interested in being referred to the Surgery-Recovery unit.

 

This recruitment will be utilized to fill full-time, part-time, and per diem positions. Please ensure to mark the first page of your employment application with your desired employment status interest (select all that are applicable).  See example screen shot below:

Type of employment you are willing to accept: Full-Time Part-Time Temporary Contract Per Diem (Health Care Services Only)