Official SealSan Joaquin County Human Resources Division


#0324-RH0160-AC
Supplemental Questionnaire

Last Name
First Name
1.

Licenses and Certificates: Possession of a license issued by the State of California as a registered nurse or paramedic is required. 

Please specify the type of license obtained and the license number: 

 

2.

Education: Graduation from an accredited four-year college or university with major in public administration, business administration, health care administration, or a closely related field is required. 

Do you currently have a bachelor's degree from an accredited four-year college? 

Yes No
 

If you answered "yes" to the previous question, please provide the name of the school attended and degree obtained:

3.

The following experience is required: 

Three years of experience equivalent to either (1) the class Pre-hospital Care Coordinator in San Joaquin County, or (2) a Mobile Intensive Care Nurse (MICN) in an emergency department of an acute care hospital, or (3) a paramedic on an advanced life support unit.

Please provide details regarding your relevant experience. Your answer must include employer name, employment dates, hours worked, and duties performed. 

4.

Substitution Pattern:

Graduation from an accredited two-year college with two years of direct administrative experience in emergency medical services systems and programs may substitute for graduation from an accredited four-year college or university with major in public administration, business administration, health care administration, or a closely related field.

If you meet the substitution pattern, please provide the school attended and degree obtained as well as the direct administrative experience in emergency medical services systems and programs: