Official SealSan Joaquin County Human Resources Division


#1219-ES2200-EX
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire.  This questionnaire is considered an extension of your employment application and must be completed.  When responding to the questions related to your experience, please provide a detailed description that includes the name of your employer, dates of employment, and job title.  Please address each question separately and number your responses.  Your responses will be reviewed to assess your qualifications.


1.

Possession of a master's degree from an accredited college or university in public health, nursing, business administration, public administration, or a related field is desirable.  Do you possess a degree from an accredited college or university?

Yes No
 

If you answered Yes, please provide the following information in the space provided below:

  • Name of college or university you attended
  • Degree obtained
  • Major
2.

Describe your professional experience planning, organizing, evaluating, and developing public health programs/policies.  For each public health program you have managed, please include the following information:

A.  Program description and responsibilities

B.  Budget role and responsibilities (including amount of operating budget)

C.  Supervision (include number of employees directly supervised and total number of employees in program)

3.

Describe your professional public health experience in the following areas (include your roles and responsibilities):

A.  Strategic Planning

B.  Implementation and monitoring of performance and quality improvement activities

C.  Grant and Contract Administration

4.

If you possess valid registration as a Public Health Nurse in the state of California, please provide your certificate number and expiration date.