Official SealSan Joaquin County Human Resources Division


#0524-RH1165-AC
Supplemental Questionnaire

Last Name
First Name
1.

Have you completed an approved Nurse Practitioner training program at an accredited college or university, or another approved certified program?
Yes No

 

Please ensure this is CLEARLY indicated in the Education section of your application.
2.

Are you currently registered as a nurse in the State of California?
Yes No
3.

Do you currently possess a furnishing license through the State of California, Board of Registered Nursing, or have the ability to obtain the State of California, Board of Registered Nursing furnishing license within one (1) year of employment?
Yes No

 

Please ensure this is CLEARLY indicated in the Professional Licenses, Certifications, or Registrations section of your application.