Official SealSan Joaquin County Human Resources Division


#0521-RH6205-AC
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess three years of progressively responsible experience as a licensed physical therapist in San Joaquin County?

Yes No
 

If you answered yes to the above question, identify the following:

  • Dates of employment
  • Job title
  • Average hours worked per week
  • Job duties
2.

PATTERN II

Do you possess four years of progressively responsible experience as a licensed physical therapist performing diagnostic therapy techniques for a variety of disabling conditions? 

Yes No
 

If you answered yes to the above question, identify the following:

  • Dates of employment
  • Name of employer
  • Job title
  • Average hours worked per week
  • Job duties
3.

Licenses and Certifications:

Do you possess a current license as a Physical Therapist issued by the Physical Therapy Board of California?

 

Yes No
 

If you answered yes to the above question, provide the following:

  • Physical Therapist license number
  • License's expiration date