Official SealSan Joaquin County Human Resources Division


#0521-RH6203-TM
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess at least one year paid work experience as a Physical Therapist in San Joaquin County?
Yes No
 

If you answered yes to question #1, identify your position title and your employment timeline.
2.

Do you possess at least two years of progressively responsible paid work experience as a licensed physical therapist performing diagnostics and therapeutic physical therapy techniques for a variety of disabling conditions in an acute care hospital setting?  
Yes No
 

If you answered yes to question 2, identify the following:

  • Job title
  • Name of employer
  • Employment timetime
  • Duties/reponsibilites performed specifically experience performing diagnostic and therapeutic physical therapy
3.

Do you possess a current license as a Physical Therapist issued by the Physical Therapy Board of California (PTBOC)?
Yes No
 

If you answered yes to question #3, identify your current PTBOC issued Physical Therapist license and the expiration date.