Official SealHuman Resource Services Department

Supplemental Questionnaire

Last Name
First Name

Applicants for this position are required to submit responses to the following supplemental questions.  Your completed responses to the supplemental questionnaire will be evaluated to determine your qualifications and must be completed properly in order to be given full consideration for the next phase in the selection process. Additionally, your responses will also be evaluated and used in the selection process in order to identify the best qualified applicants.

Responses should be thorough and specific.  A lack of detail and explanation in the supplemental questions and in your application may result in failure or disqualification for this position.  Clarity of expression, content, experience, 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 properly completed 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.

Do you understand the above statement?

Yes No

Do you possess a current, valid license in the State of California as a Registered Nurse, EMT-Paramedic, or Physician's Assistant?

Yes No

If you answered yes, please list the type of license, license number, and expiration date (if any).


Do you possess a current, valid driver's license in the State of California? If yes, please ensure this information is accurate on your application.

Yes No

Have you completed three (3) years of full-time, progressively responsible experience performing program design, planning, implementation, and/or evaluation in a health care organization focused on the provision of emergency medical services?

Yes No

Please describe, in detail, your experience in the field of emergency medical services.


Please describe your work experience in prehospital care administration, including program design, planning, implementation, and evaluation responsibilities.


Describe your knowledge of clinical policies and procedures for prehospital emergency medical services care.


Describe your knowledge of Federal, State and County codes, statutes, ordinances and regulations governing emergency medical services.


The supplemental questions were designed to elicit your experience as it relates to the current recruitment in order to identify the best qualified candidates for this position.  Only the best and most suitably qualified candidates will be invited to participate in the oral interviews.

By selecting yes below, you certify your understanding that all applicants who meet minimum qualifications are not guaranteed to move forward in the process. 

Do you understand the above statement?


Yes No