Official SealSan Joaquin County Human Resources Division

Supplemental Questionnaire

Last Name
First Name


PLEASE NOTE: We do NOT accept resumes in lieu of a completed application. Please ensure that all information needed to evaluate your qualifications is listed on your application (including mandatory attachments). Failure to provide this information may result in the denial of your application. 


Are you currently registered as a nurse in the State of California?

Yes No


Please ensure this is CLEARLY indicated in the Professional Licenses, Certifications, or Registrations section of your application. 


Do you have a Bachelor's Degree in Nursing or a related field?

Yes No


Please ensure this is CLEARLY indicated in the Education section of your application.


Please indicate how many years you have of progressively responsible experience as a registered nurse in an acute care setting: 

None/Less than one year
One year
Two years or more


Please ensure this is CLEARLY demonstrated in the Employment Experience section of your application.

Note: resumes will not be accepted in lieu of a completed application. 


Please indicate which of these certifications you hold:

*** Copies MUST be provided with application ***

Mobile Intensive Care Nurse (MICN)
Advanced Cardiac Life Support (ACLS)
Other certification in area of specialty
None of the above