Official SealSan Joaquin County Human Resources Division


#0820-RH3030-AC
Supplemental Questionnaire

Last Name
First Name
1

PATTERN I

Have you completed an approved operating room technician training or program within the past five (5) years?

If you answered no, go to question #4.

Yes No
2

If yes, did the program include completion of 500 externship hours?

Yes No
3

If you responded yes to questions 1 and 2, please provide the following information:

  1. Name of institution
  2. Type of certification  (ie: Surgical Technician, Operating Room Technician, etc.)
  3. Date of program completion

Note: A copy of certification must be provided with the completed employment application. It may be attached to your online application, sent via email to kparker@sjgov.org, or by fax to 209-468-0508.

4

PATTERN II

Do you possess at least one year of full-time paid sub-professional nursing experience (comparable to a LVN) in an acute care hospital setting. 

Please note that acute care is a level of care where patients are treated for a brief acute episode of illness, for conditions that are the results of a disease or trauma, and during recovery from surgery. Acute care is generally only provided in hospitals where all of the following medical units/services are provided:

  • Emergency
  • Medical Surgical
  • Labor and Delivery
  • Intensive Care Unit
Yes No
5

Please describe your experience working in a sub-professional nursing capacity (comparable to a LVN) in an acute care hospital.  Include a detailed description of the specific duties you performed and the volume of patients you served.  If you do not possess this experience, please note "N/A" below.

6

Please describe in detail the patient care duties you performed in an acute care hospital. If you do not possess this experience, please note "N/A" below:

7

This position will require employees to work rotational assignments of "on-call" duty. When on-call, employees must be able to report to San Joaquin General Hospital's OR Department within 30 minutes of being contacted.

By selecting "yes", you are indicating that you understand that during your rotational assignment, you are required to report to the San Joaquin General Hospital's OR Department within 30 minutes of being contacted for on-call duty.

Yes No