Official SealSan Joaquin County Human Resources Division


#0621-TH9257-TM
Supplemental Questionnaire

Last Name
First Name
1.

Current enrollment in an approved Registered Nurse curriculum is required.  Please check mark what semester you are currently enrolled in:

First semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Second semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Third semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Fourth and final semester of an approved two-year registered nurse curriculum OR in subsequent semesters of a Registered Nurse baccalaureate program with a grade average of "C" or better.
I am not enrolled in an approved Registered Nurse curriculum.

2.

If you indicated enrollment in an approved Registered Nurse curriculum, please:

1)  Clearly list the name of school/program on your employment application; and

2)  Submit a copy of your unofficial transcript demonstrating a grade of "C" or better by the final filing deadline. 

Note: You may submit your transcript by either a) Attaching it to your online application; b) Faxing to (209) 468-6271 (indicate the recruitment number); c) Mailing to Human Resources, 44 N. San Joaquin St., Suite 330, Stockton, CA 95202, or d) Dropping off at SJGH Human Resources, Room 1407 at 500 W. Hospital Rd., French Camp, CA 95231.


3.

Do you possess paid work experience performing duties equivalent to those of a nursing aide in an acute care facility? 

Yes, I have six months of paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
Yes, I have one year of paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
Yes, I have eighteen months of paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
No, I do not have any paid work experience performing duties equivalent to a nursing aide in an acute care facility.
4.

If you indicated yes to question 3, please provide a description of the typical duties you performed in an acute care facility.

Include in your answer, 1) Job Title, 2) Name of Employer, 3) Dates of Employment and 4) Hours worked per week.