Official SealSan Joaquin County Human Resources Division


#0122-RS0302-AC
Supplemental Questionnaire

Last Name
First Name

 

Please provide responses to the following questions.  This supplemental questionnaire is an extension of your employment application and will be reviwed to thoroughly assess your qualifications.  Resumes are not accepted in lieu of completing this questionnaire.

When responding to questions relating to your work experience, please provide a detailed description that includes the name of your employer, dates of employment (beginning and end dates), job title, number of hours worked per week, and indicate if experience was paid or unpaid.


1.

Have you completed at least 12 semester (or equivalent quarter) units from an accredited college or university in child development, including at least 3 semester (or equivalent quarter) units in infant care?

Yes No
1a.

If you answered Yes, please provide the following information:

  • Name of accredited college or university attended
  • Course number and title
  • Number of units received
  • Indicate if semester or quarter units

Note: Please provide all information requested regarding your units.  This information will help to assess your qualifications and determine if you meet the minimum requirements.

2.

Do  you possess at least one year of full-time paid childcare experience in a licensed day care center or comparable group childcare program which included experience working with drug exposed infants and young children?

Note:  Volunteer or unpaid experience does not count towards meeting this requirement.

Yes No
2a.

If you answered Yes, please provide a detailed description of your experience and include the following information:

  • Name of employer (indicate if employer was a licensed center or program)
  • Employment dates
  • Job title
  • Number of hours worked per week
  • Specific duties performed

Note:  This section regarding your experience must be completed.  A resume is not accepted in place of or as a response to this question.  Providing all information requested will assist in assessing your qualifications.

3.

Possession of a valid California driver's license may be required by the nature of the assignment.  Please provide your driver's license number and expiration date.

4.

Availability:

Please acknowledge that you understand this position will require employees to work rotating shifts.

I understand that this position will require that I am available to work rotating shifts.