In addition to your application and curriculum vitae, please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and must be completed. This is an important part of your application package that will allow us to thoroughly assess and evaluate your qualifications for this position. When responding to the questions related to your experience, please provide a detailed descriptionthat includes the name of your employer, dates of employment, and job title.
1.
Do you possess an unrestricted Physician and Surgeon License to practice medicine in the State of California?
Yes
No
If YES, please provide your California Medical License number and expiration date.
2.
For each board certification you possess, please provide the following information:
Specialty
Date received
Expiration Date
3.
Do you possess a master's degree in public health?
Yes
No
If YES, please provide the following information:
Name of college or university from which you graduated
Degree conferred
Emphasis
4.
Please describe your experience practicing medicine as a licensed physician and include whether this experience was in a field related to public health.
5.
Please describe some public health issues you are interested in along with how you have addressed them in your past roles or would go about addressing them as the Assistant Public Health Officer.
6.
Do you possess a valid California driver's license?
Yes
No
If YES, please provide your driver license number and expiration date.
San Joaquin County Human Resources Division