Official SealSan Joaquin County Human Resources Division


#0921-RH6404-AC
Supplemental Questionnaire

Last Name
First Name

 

Copies of licenses and certifications must be submitted with the completed employment application. Failure to provide copies of the required licenses and certifications may result your application to not be considered. Copies of the licenses and certifications may be submitted when prompted to upload a resume or emailed to Bruce Cager at bcager@sjgov.org. 



 

 FOR ALL APPLICANTS


1.

Do you possess a current licensure as a Speech Pathologist issued by the California Speech-Language Pathology and Audiology and Hearing Aid Dispensers’ Board and a Certificate of Clinical Competency in Speech Pathology issued by the American Speech-Language-Hearing Association.

Yes No
 

If yes, identify the license number and certificate number and expiration dates for both the license and the certificate.


 

 

FOR SPEECH THERAPIST IV - CLINICAL APPLICANTS ONLY


2.

Either PATTERN I

Do you possess at least three years paid work experience as a licensed Speech Therapist in San Joaquin County?

If yes, identify the following:

  • Your position title
  • Employment timeline
  • Average hours worked per week

 


 

Or PATTERN II


3.

Do you possess at least four years of progressively responsible paid work experience as a licensed Speech Therapist pathologist performing diagnostic and therapeutic speech pathology techniques for a variety of disabling conditions? If yes, identify that following:

  • Name of employer
  • Position title
  • Position duties
  • Timeline of employment
  • Average hours worked per week

 


 

And for both PATTERNS

Substitution:  Satisfactory completion of a Clinical Fellowship Year from the American Speech-Language-Hearing Association while employed at San Joaquin General Hospital may be substituted for one year of the required experience.

Special Requirement:  Must possess certificates of completion for at least three courses in an area of clinical specialty as approved by the Department of Health Care Services or San Joaquin General Hospital.

A. Are you utilizing the substitution option?  If yes, provide evidence of completion of a Clinical Fellowship Year while employed at San Joaquin County. Email evidence to bcager@sjgov.org.

B. Do you possess certificates of completion for at least three courses in an area of clinical specialty as approved by the Department of Health Care Services or San Joaquin General Hospital? If yes, email proof to bcager@sjgov.org.

 



 

FOR SPEECH THERAPIST III - SENIOR  APPLICANTS ONLY


4.

EITHER PATTERN I

Experience:  Two years of progressively responsible experience as a Speech Therapist II in San Joaquin County service. If yes, provide the following:

  • Name of County department
  • Your position title
  • Position duties
  • Timeline of employment
  • Average hours worked per week

 

 

Or PATTERN II

Experience:  Do you possess three years of progressively responsible experience as a licensed speech pathologist performing diagnostic and therapeutic speech pathology techniques for a variety of disabling conditions.  If yes, identify the following:

  • Name of employer
  • Position title
  • Duties performed
  • Timeline of employment
  • Average hours worked per week

 

And for both PATTERNS

Substitution:  Satisfactory completion of a Clinical Fellowship Year from the American Speech-Language-Hearing Association while employed at San Joaquin General Hospital may be substituted for one year of the required experience.

A. Are you utilizing the substitution option?  If yes, provide evidence of completion of a Clinical Fellowship Year while employed at San Joaquin County. Email evidence to bcager@sjgov.org.

 



 

FOR SPEECH THERAPIST II - STAFF APPLICANTS ONLY


5.

Licenses and CertificatesDo you possess a current licensure as a Speech Pathologist issued by the California Speech-Language Pathology and Audiology and Hearing Aid Dispensers’ Board; and possess a Certificate of Clinical Competency in Speech Pathology issued by the American Speech-Language-Hearing Association?  If yes, identify the license and certification numbers along with the expiration date of each.