Official SealSan Joaquin County Human Resources Division


#0422-RH3200-TM
Supplemental Questionnaire

Last Name
First Name

 

For Correctional Health Services positions:

Prior to and as a prerequisite for employment, a background investigation will be conducted by the Sheriff’s Department which will result in the grant or denial of a security clearance. If granted, the failure to maintain a security clearance will result in termination from County employment.


1
PATTERN 1

Have you completed a Medical Assistant program of training? (A copy of completion of the training or program needs to be submitted with employment application)

Yes No
 

If yes, please specify:

 

  • name of program/school:
  • start of program/school:
  • date of program completion: 
  • date certificate/degree received:
2

PATTERN 2 Do you possess one year of experience performing as a medical or outpatient clinical assistant in a medical or clinic office?

Yes No
 
Did this experience include both clerical and unlicensed assistive patient care duties?

Yes No
3
PATTERN 3

Do you possess one year as a Nursing Assistant or Hospital Unit Clerk with San Joaquin County?

Yes No
 
This pattern requires completion of 15 units from an accredited college or approved school in at least 3 of the following subject areas.

Please indicate which of the subject areas combine for at least 15 units.

Medical Terminology
Anatomy
Physiology
Psychology
Medical Office Practices
4
PATTERN 4

Have you successfully completed an approved Paramedic (EMT-P) education program accredited in the State of California? (Note: the program of study must include clinical and didactic practices)

Yes No
 
If yes, please specify:

  • name of program:
  • date completed: