Official SealHuman Resource Services Department


#18-8164-01
Supplemental Questionnaire

Last Name
First Name
 

Thank you for your interest in the position of Fire Department EMS Quality Improvement & Education Coordinator. Your completed response to this supplemental questionnaire will be evaluated to further determine your qualifications.

Responses should be thorough and specific, yet concise and succinct. A lack of adequate detail in the supplemental questions and in your application, may result in failure or disqualification for this recruitment. Neatness, clarity of expression, grammar, spelling and the ability to follow instructions will be considered in the evaluation process. A resume will not be accepted as a substitute for a thoroughly completed employment history and supplemental responses.

Information provided in your responses to the supplemental questionnaire regarding your employment experiences must also be detailed in the Work Experience section of the application for this recruitment.  Please be sure to list all employers and required information, on your application, especially if you are referencing those employers in your responses to the supplemental questions.

By selecting 'YES' below, you certify your understanding of this statement:

Yes No
1

Do you have a current valid California Class C driver's license?

Yes No
2

Do you have a current valid California Registered Nurse License? (In your response, please include the California RN license # and expiration date).

3

Do you have a current valid California Paramedic License? (In your response, please include the California Paramedic license # and expiration date)

4

Describe your experience working with a pre-hospital care system and/or emergency room. (In your response, please include the employer's name, your job title, years and months of experience)

5

Describe your experience as a Critical Care/Trauma/Emergency Nurse/or California licensed Paramedic. (In your response, please include the employer's name, your official job title, years and months of experience)

6

Please describe, in detail, your experience working with the administration and management of an emergency medical service program for a government EMS agency. (In your response, please include your role, responsibilities, title, dates of employment and the name of the government EMS agency)

7

Please describe your experience in the planning, development and implementation of comprehensive and effective EMT-P and EMT-1 training programs.

8

Special Requirements:

Incumbents in this positions will occasionally be required to periodically respond to emergency situations to evaluate paramedic/EMT performance. This job duty requires the incumbent of the Fire Department EMS Quality Improvement & Education Coordinator position to be physically capable of getting on and off fire apparatus in an emergency setting.

To the best of your knowledge, do you meet this requirement?

Yes No

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