Official SealSan Joaquin County Human Resources Division


#0322-RF0300-PC
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess six months of full-time (40 hours/week; 2080 hours/year) paid work experience?
Yes No
2.

If you answered yes to the previous question, please specify:

  • Job title
  • Name of facility/business
  • Specific duties
  • Dates of employment
  • Average hours worked per week
3.

PATTERN II

Have you completed an approved training program in general cleaning methods and procedures?
Yes No
4.

If yes, please specify:

  • Name of program/school:
  • Date of program completion: 
  • Date certificate/degree received:
5.

As a 24-7 facility, San Joaquin General Hospital employees may be asked to be available to work any shift. 

Listed below are various examples of shifts. Please check all shifts you are interested in:
Days: 7:00AM - 3:00PM
PMs: 3:00PM - 11:30PM
Nights: 10:30PM - 7:00AM
6.

Incumbents employed as Housekeeping Service Workers will be exposed to the following hazards on a daily basis:

  • Diseases including COVID - 19
  • Infectious germs
  • Bodily Fluids such as 
    • blood
    • vomit
    • fecal matter
    • urine
I read and acknowledge the potential hazards that may be experienced by Housekeeping Service Workers in San Joaquin General Hospital.