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.

You are required to possess a Registered Nursing License issued by the California Board of Registered Nursing to qualify for this position. Please provide your current Registered Nursing License number below. If you do not have a current California Registered Nursing License, you will be disqualified and will not move forward in the selection process.

You are required to possess a Public Health Nursing Certificate isssued by the California Board of Registered Nursing to qualify for this position. Please provide your Public Health Nursing certificate number below. If you do not have a current California Public Health Nursing certificate , you will be disqualified and will not move forward in the selection process.