Official SealSan Joaquin County Human Resources Division


#0720-RF0300-TM
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess six months of full-time (40 hours/week; 2080 hours/year) paid work experience?
Yes No
2.

If you answered yes to the previous question, please specify:

  • Job title
  • Name of facility/business
  • Specific duties
  • Dates of employment
  • Average hours worked per week
3.

PATTERN II

Have you completed an approved training program in general cleaning methods and procedures?
Yes No
4.

If yes, please specify:

  • Name of program/school:
  • Date of program completion: 
  • Date certificate/degree received:
5.

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 shifts. Please check all shifts you are interested in:
Days: 7:00AM - 3:00PM
PMs: 3:00PM - 11:30PM
Nights: 10:30PM - 7:00AM
6.

Incumbents employed at San Joaquin General Hospital (SJGH) will work at San Joaquin General Hospital and other San Joaquin County areas and may be exposed to the following hazards:

WORK AREAS

  • SJGH - Surgery Suites
  • SJGH - Trauma rooms
  • SJGH - Labor rooms
  • SJGH - Patient rooms
  • SJGH - Medical Guarded Unit
  • San Joaquin County Clinics
  • San Joaquin County Jail
  • San Joaquin County Morgue
  • Juvenile Justice Center

 HAZARDS

  • Infectious germs
  • Constant contact with body fluids:
    • blood
    • vomit
    • fecal matter
    • urine
I read and acknowledge the potential work areas and hazards that may be experienced by Housekeeping Service Workers in San Joaquin General Hospital.