Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name

San Joaquin General Hospital is a 24/7 running facility. Employees are expected to be open to working rotating shifts that will include nights, weekends and holidays. Are you available to work in a position that has these requirements?

Yes No

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

Do you possess a Bachelor’s Degree in Nursing? (Please Note: If yes, be sure to clearly identify your degree either on the education portion of your employment application or resume as it will be source verified).


Yes No

Do you possess nursing National Certification?(A copy of your certification must be submitted with employment application in order to be considered)

Yes No

Licenses and Certificates:

In order to qualify for this position you must have successfully completed Neonatal Resuscitation Class, ICN Class, Transport Nurse Certification, 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:

Yes, I have completed an approved Neonatal Resuscitation Class
Yes, I have completed an ICN Class
Yes, I possess a Transport Nurse Certification
Yes, I have completed an approved Preceptor Class (or adult educator/trainer equivalent)
I have not completed any of the above mentioned courses/certification