Department of Human Resources

2322 Nurse Manager
Specialty: Medical Surgical
Supplemental Questionnaire

The purpose of this Supplemental Questionnaire is to determine if you meet the minimum qualifications of a 2322 Nurse Manager in the Med-Surg specialty, and to determine your knowledge, skills, and abilities in job-related areas that have been identified as critical for satisfactory performance in this specialty.

Responses to supplemental questionnaire items must be supported by the information provided in the body of your application (i.e. education and training/employment record section) in order to receive appropriate credit, and are subject to verification. Verification of experience, licensure, and possession of valid certifications/certificates may be collected at any time during or after the selection process.

INSTRUCTIONS: Please answer all applicable questions by choosing the best response that matches your education, experience, certifications, licenses, and/or by providing the information requested.

Part One: Education & Experience Qualifications

Instructions For Questions 1 - 4:

Please answer all applicable questions by choosing the best response that matches your education, experience, certifications, and licenses.

Do you possess a valid permanent/temporary (including interim permit) California Registered Nurse License issued by the California Board of Registered Nursing?

As a reminder, all licenses must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the "Professional Licenses, Certifications or Registrations" section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update the appropriate section before submitting your application.

What is the highest level of education that you have completed?

As a reminder, all education must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the education you are about to describe in the Education section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update your Education before submitting your application.

How much verifiable full-time equivalent work experience do you have working as a Registered Nurse in a general acute care hospital, ambulatory clinic, or community/public health setting, within the last five (5) years? (Full-time experience is equivalent to 40 hours per week.)

As a reminder, all work experiences must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the Experience section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update your Experience before submitting your application.

How much verifiable full-time equivalent experience do you have working as a charge nurse, assistant nurse manager, or nurse manager in an Ambulatory setting? (Full-time experience is equivalent to 40 hours per week.)

As a reminder, all work experiences must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the Experience section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update your Experience before submitting your application.

Part Two: Training & Experience Evaluation

Instruction for Questions 4 - 9:

Review the questions first, prepare and save your responses in a word processing document, and then paste them into the online Supplemental Questionnaire.

- Be concise but thorough.  Ensure that you address all parts of the question.  Your written communication skills will be evaluated based on your responses.
- Ensure that your responses are sufficiently detailed to assist in evaluating your knowledge, skills, and abilities.
- Provide your best or highest examples of work.
- Answer all questions independently (e.g., do not reference your responses in prior questions).  Provide all information requested even if they appear redundant.  Do not write "see application" or "see resume" as a response.
- If you do not have the experience that relates to the question(s) below, please enter "N/A" as your response.

Which of the following valid American Heart Association Cardiopulmonary Resuscitation (CPR) Certificates do you possess?

If you answered "None of the above" to question 5, please provide an explanation.

Which of the following electronic medical records software systems do you have experience using?

If you selected "Other" in question 6., please specify below.

How much verifiable full-time equivalent work experience do you have as a health care provider serving a diverse urban population? (Full-time experience is equivalent to 40 hours per week.)

How much verifiable full-time equivalent work experience do you have providing chronic disease care management? (Full-time experience is equivalent to 40 hours per week.)

Which of the following Certifications do you possess?

If you answered "Other" in question 9, please specify below.