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Human Resources Department
#19-337170-01
Supplemental Questionnaire

Last Name First Name
 
 

I understand that proof of my Medical Degree, license and certifications must be submitted for this position.

 

  • Medical Degree (MD or DO) from an accredited college or university
  • Current and active license to practice medicine in the State of California issued by the Board of Medical Examiners
  • Valid certification by a specialty board in Family Medicine, Internal Medicine, Pediatrics, Preventive Medicine or equivalent that is recognized by the American Medical Association or American Osteopathic Association
  • Valid and current Drug Enforcement Agency (DEA) license

 

I will be submitting all of the above in the following manner:
Uploading to my employment application prior to submittal
Emailing to recruitment@solanocounty.com
Faxing to (707) 784-3424
Mailing or hand delivering to 675 Texas St., Suite 1800, Fairfield, CA 94533