Official SealSan Joaquin County Human Resources Division


#0624-RH1106-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a current registration as a nurse in the State of California? if yes, please be sure to include your license number where requested on the application.
Yes No
2.

Licenses and Certificates:

In order to qualify for this position you must have proof of successful completion of a Critical Care Class and Preceptor Class. (Please note that proof of completion must be submitted with your employment application in order to be considered. Please upload certifications when prompted to upload a resume). Please check all that apply below:
Critical Care Class
Preceptor Class or equivalent
I have not completed any of the above mentioned courses/certifications.
3.

Please note the education and national certification that you possess below. Education must clearly be annotated on your employment application. A copy of your National Certification must be submitted with your employment application in order to be considered. Please check all that apply:
Yes, I possess a Bachelor's of Science Degree in Nursing or related field.
Yes, I possess National Certification.
I do not possess a Bachelor's Degree in Nursing or National Certification.
4.

Do you possess Two (2) years of progressively responsible experience as a registered nurse in an acute care hospital Progressive Care Unit, including one (1) year at a level equivalent to a San Joaquin County Staff Nurse IV?
Yes No