Last Name | |
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First Name |
1. PATTERN I Experience - Do you possess two years of progressively responsible experience as a registered nurse, one year of which includes Clinical Information Systems experience, in an acute care or ambulatory care setting at a level equivalent to a San Joaquin County Staff Nurse III? |
Yes No |
If you answered yes, provide the following:
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2. OR PATTERN II Education: Do you possess a Bachelor's Degree in Nursing, Health Science, or closely related field? |
Yes No |
If you answered yes, provide the following:
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2b. Experience: Do you possess one year of progressively responsible Clinical Information Systems experience as a registered nurse in an acute care hospital or ambulatory care setting at a level equivalent to a San Joaquin County Staff Nurse III? |
Yes No |
If you answered yes, provide the following:
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3. License and Certificates: Do you possess current and valid registration as a registered nurse in the State of California? if yes, provide the license number and the expiration date. |
4. Special Requirements: Mark active certifications/classes that you currently possess or have completed. (Check all that apply) |
Advanced Cardiac Life Support (ACLS) Certification |
SJC Mobile Intensive Care Nurse (MICN) Certification |
Preceptor Class or Equivalent |
Critical Care Class |
PALS Certification |
EKG Class |
ED Essentials or Equivalent |
MSE Triage |
I do not possess any of the above certification or class completions |