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Human Resources Department
#18-332030-01
Supplemental Questionnaire

Last Name First Name
 

 

This Supplemental Questionnaire will be used to determine applicants’ qualifications for this position and assess an applicant’s ability to advance in the recruitment process; therefore, applicants are encouraged to answer all questions thoroughly and completely.  Omitted information will not be considered or assumed.  Applicants who have no experience in a specific area are recommended to state "no experience in this area" instead of leaving the space blank.
1

I currently possess, or have the ability to obtain, a valid Public Health nursing certificate issued by the California Board of Registered Nursing.
Yes No
2

My current California Public Health Nursing certificate number is: