Official SealSan Joaquin County Human Resources Division


#0724-RH2505-01
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid license as a Psychiatric Technician issued by the Board of Vocational Nurses and Psychiatric Technician examiners of the State of California?
Yes No
1A.

If Yes, please provide your valid Psychiatric Technician license number and expiration date.
2.

Do you possess two years of full-time paid experience at a level equivalent to Senior Psychiatric Technician in the the San Joaquin County Mental Health Services Department?
Yes No
2A.

If Yes, please decribe your two years of full-time paid journey-level experience that included responsibility for participating as a member of a treatment team providing skilled physical and psychiatric care for mentally or emotionally disturbed patients in a variety of treatment programs, and include the following:

  • Name of employer
  • Job title
  • Dates of employment
  • Number of hours worked per week
  • Specific job duties performed
  • Indicate if experience was paid or volunteer
3A.

If you are a county employee,  please indicate the department to which you are currently assigned.
Health Care Services-Administration
Behavioral Health Services
Correctional Health Services
Emergency Medical Services
Public Health Services
Veterans Services
None of the above
3B.

Please provide your employee ID number and current job title: