Official SealSan Joaquin County Human Resources Division


#0823-RO1010-AC
Supplemental Questionnaire

Last Name
First Name

 

To qualify, you must possess three years of experience performing insurance billing, collections, or accounts receivable in a hospital environment within the last five (5) years.
 

If you meet this requirement, please select the type of hospital experience you possess which qualifies:
Hospital Insurance Billing
Hospital Collections
Hospital Accounts Receivable
None of the above
 

Please provide the name of the hospital where you were employed:
 

Please provide the dates of employment (to qualify, the experience must have been within the last 5 years):