Official SealHuman Resource Services Department


#22-5390-02
Supplemental Questionnaire

Last Name
First Name
1.

Thank you for your interest in the Deputy Director, Public Health Nursing (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.

Do you understand the above statement?

Yes No
2.

Please describe your professional experience as a Nurse Manager or other higher level nursing position(s), including experience in personnel management. In your response, please elaborate on your involvement in the management and direction of a multi-faceted nursing program or division and multi-disciplinary staff.

3.

Describe your experience in program and budget development, organizational/operational planning, development, and evaluation and the coordination of community resources.

4.

Please explain the knowledge, skills and experience you have to be an effective nurse leader.

5.

Describe the methods you use to evaluate the work of staff and how do you ensure staff are trained in clinical/program procedures.

6..

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

Do you possess a California Public Health Nursing (PHN) Certificate?

Yes No
6a.

If yes, please indicate you certificate number, issuance and expiration dates in the space provided below, otherwise please type "N/A".

7.

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

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