Official SealHuman Resource Services Department


#22-5320-02
Supplemental Questionnaire

Last Name
First Name
1.

Thank you for your interest in the Registered Nurse IV (PHN Option) position. 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.


By selecting yes below, you certify your understanding of this statement.

Yes No
2.

Please describe your nursing experience within the last five years in a clinical and/or public health setting. In your response please also describe your lead/supervisory experience.

3.

Please describe your clinical and managerial experience serving the following multicultural, high-risk populations:

    1. Individuals with communicable diseases
    2. Individuals across the lifespan with complex medical and psychosocial needs
4.

Please describe your method of evaluating programs and nursing interventions using a health equity lens. In your response, please elaborate on your approach when evaluating program effectiveness, addressing accountability and implementing quality improvement measures.

5.

Describe the approaches and methods you use to successfully lead, manage and supervise a multidisciplinary team and maintain effective work relationships.

6.

This position requires candidates to possess a license as a Registered Nurse issued by the California Board of Registered Nursing.

Please indicate your license number, issuance and expiration dates in the space provided below. If you do not possess such license, please type "N/A".

7.

This position requires the possession of a current and valid California Public Health Nursing (PHN) certificate issued by the California Board of Registered Nursing.

Please indicate your license number, issuance and expiration dates in the space provided below. If you do not possess such license, please type “N/A”.

8.

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 next step in the process.

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

E-mail | Phone: (510) 272-6471 | 8am - 5pm M-F | Powered by JobAps