Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name


Please submit responses to the following questions. When answering the questions below related to your experience, please provide a detailed description that includes the name of your employer, your dates of employment, and your job title.  These questions will be reviewed by the screening panel in evaluating your qualifications. 


Do you possess a Registered Health Information Technician (RHIT) Certification issued by the American Health Information Management Association?

(Certificate must be submitted as an attachment to your employment application or via email to

Yes No

Substitution for RHIT Certification: Have you completed an approved program for Registered Health Information Technician (RHIT)?

(To find out if your program is accredited please visit this link. If your program is not listed, it is not an approved program.)

Yes No

If you did complete an approved program, please list the name of the school attended and the degree awarded.


Please describe, in detail, your one year of journey level experience coding diseases and operations using the standard classification system.

List: Name of employer, your job title, dates of employment, hours worked per week, detailed description of job duties which must include six months of as a lead or supervisor.


What type of facility did the above experience take place in:

Acute care hospital
Mental health inpatient facility
Skilled nursing facility
Large group-practice/medical clinic
None of the above