Official SealSan Joaquin County Human Resources Division


#1020-RH5353-TM
Supplemental Questionnaire

Last Name
First Name
1

Do you possess at least one year of full-time (40 hours per week/2080 hours) paid experience as a licensed respiratory care practitioner in an acute care hospital? 
Yes No
1a

If yes, please provide the following information:

  • A description of the specific duties performed as a licensed respiratory care practitioner in an acute care hospital
  • Your experience intubating critically ill babies or adults, if any
  • Dates of employment
  • Number of hours worked per week
2

Please indicate if your experience was gained from one of the following:
Long Term Acute Care (LTAC)
Skill Nursing Facility (SNF)
Other
3

Please indicate if you possess experience in the following:
Intubating infants
Intubating adults
Transporting critically ill babies
All of the above
None of the above
3a

Please provide your Respiratory Care Practitioner license number. (Write "none" if you do not possess a valid California Respiratory Care Practitioner license.)
3b

By clicking on the box, I acknowledge and accept that an offer of employment as a Respiratory Care Practitioner II is conditional on my ability to provide proof of a high school diploma or equivalent as required by the California Association of Pathology for non-waive testing.
4

Position(s) may rotate or be assigned to the Medical Guarded Unit. As a condition of employment, candidates assigned to the Medical Guarded Unit must successfully pass a California Department of Corrections (CDCR) background investigation conducted by the California Depatment of Corrections and Rehabilitation. Candidates must also maintain their CDCR clearance for continued employment in this unit. Please check the below box to acknowledge you understand and will comply with the above terms.
Yes, I acknowledge and understand the above terms.