Official SealSan Joaquin County Human Resources Division


#1119-RH1104-AC
Supplemental Questionnaire

Last Name
First Name

 

Please attach applicable licenses and certificates to the online employment application.  Failing to provide a copy of your licenses and certificates may result in a failure to move forward in the selection and hiring process.  All relevant RN experience should be included in the application.


1.

Education:

Do you possess a Bachelor's Degree or Master's Degree in Nursing or closely-related field. (If a closely-related field, please be sure to clearly indicate the type of degree in the "education" portion of your employment application.)

Bachelor's Degree in Nursing
Master's Degree in Nursing
Bachelor's or Master's in closely-related field
Does not apply
2.

License:

Provide your current RN License Number so that it can be source verified with the State of California Board of Registered Nursing. If you do not possess a valid or current RN License, please note "N/A":

3.

The following section will be utilized to determine if you possess the license and/or certifications required to qualify as a Staff Nurse IV for a specific inpatient unit.  Copies may be attached to your online application, emailed to jripp@sjgov.org, or faxed to (209) 468-0508 ATTN: J. Ripp.

Please indicate if you possess any of the following certificates:

ACLS
BLS
PALS
Preceptor course or Nursing training certificate
Chemotheraphy certification
National certifications (CEN, CCRN, CNN, CDN, CPAN, CNOR, PCCN)
Other
None of the above
 

If other was selected, identify the licenses and/or certificates.

4.

San Joaquin General Hospital is a 24/7 running facility. Employees are expected to be open to working rotating shifts that will include nights, weekends and holidays.

 

As a condition of employment, Staff Nurses assigned to the Perioperative Units (Surgery-Recovery, PACU) must be able to take standby call on a rotational basis. While on call, nurses must possess the ability to return to the hospital within 30 minutes. Are you available to work in a position that has these requirements?

 

Yes, I understand that this position requires the ability to work rotating hours and take standby call. Should I be selected for the position, I have the ability to meet the 30 minute response requirement while on Standby Call duty.
No, I understand that this position requires the ability to work rotating hours and take standby call, however I am unable to meet the 30 minute response requirement for this unit.
5.

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.