Official SealSan Joaquin County Human Resources Division


#0924-RH2001-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid license as a Vocational Nurse issued by the State of California, Board of Vocational Nurse and Psychiatric Technician Examiners?
Yes No
 

License Number AND Expiration Date
2.

Do you possess a valid Interim Permit issued by the State of California, Board of Vocational Nurse and Psychiatric Technician Examiners?
Yes No
 

License Number AND Expiration Date