Official SealSan Joaquin County Human Resources Division

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):