Official SealSan Joaquin County Human Resources Division


#0125-RH5002-PC
Supplemental Questionnaire

Last Name
First Name
1

Do you have eighteen months of experience performing radiographic work? (Please ensure that this experience is listed in the work history section of your application)
Yes No
2

Graduation from the San Joaquin General Hospital School of Radiologic Technology may be substituted for six months of the required experience.

Did you graduate from the San Joaquin General Hospital School of Radiologic Technology?
Yes No
3
Are you currently registered with the American Registry of Radiologic Technologists?
Yes No
 
If you responded yes, please identify your ARRT ID number.
4
Do you have current certification by the State of California Department of Health as a Radiologic Technologist?
Yes No
 
If you responded yes, please identify your license number
5

Special Requirement: Possession of a State of California Certification in mammography or a State of California fluoroscopy permit may be required as a condition for assignment or continued assignment as a Radiologic Technologist II.

Do you have a current certification in mammography or a fluoroscopy permit issued by the State of California?
Yes No
 
If you responded yes, please identify your mammo certification and/or fluoroscopy permit number.
6
Do you have a current fluoroscopy permit issued by the State of California?
Yes No
 
If you responded yes, please identify your license number.