Official SealSan Joaquin County Human Resources Division


#0621-RH1820-01
Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


1.

Do you possess a bachelor's degree from an accredited college or university with a major in Nursing?

Yes No

 

If you answered Yes, please be sure your education and degree information is clearly identified in the education section of your employment application.


2.

Do you possess a valid registration as a Public Health Nurse in the state of California?

Yes No
 

If you answered Yes, please provide your Public Health Nurse license number and expiration date.

3.

This position requires a valid California Driver's License.  Do you possess a valid California Driver's License?

Yes No
 

If you answered Yes, please provide your license number and expiration date.

4.

Do you have three (3) years of full-time paid progressively responsible professional nursing experience working with multiple programs in a public health setting, including one year of supervisory experience?

Yes No
 

If you answered Yes, please describe your qualifying experience and include the following information:

  • Name of employer
  • Dates of Employment
  • Number of hours worked per week
  • Job Title
  • Specific job duties performed, including supervisory duties
  • For supervisoryexperience, include the number of staff you supervised and include their job titles

This section must be completed.  A resume is not accepted in lieu of completing, or as a response to, this question.  Providing all information requested will assist in assessing your qualifications.

Note:  A master's degree in Nursing, Public Health, or closely related field may substitute for one year of the required non-supervisory experience.  If qualifying under this substitution pattern, please be sure your education and degree information is clearly identified in the education section of  your application.