Official SealSan Joaquin County Human Resources Division


#0120-RH3031-01
Supplemental Questionnaire

Last Name
First Name
1

Do you possess at least one (1) year of full-time paid work experience as an Operating Room Technician I in San Joaquin County?

Note: If you respond yes, go to question #4.

Yes No
2

Do you possess at least one (1) year of full-time (40 hours per week) paid work experience as a surgical or operating room technician in an acute care hospital within the past five (5) years?

Yes No
 

Please describe the specific duties performed as an operating room or surgical technician for an acute care hospital. If you do not possess experience in an acute care hospital, please note "N/A" below:

3

Have you successfully completed an approved Surgical Technician training or program?

(NOTE: Must provide proof of successful completion with employment application in order to be considered; submit with application or send to kparker@sjgov.org, or fax to (209) 468-0508.

Yes No
 

If yes, provide the following information:

  1. Name of institution
  2. Type of certification (ie: Surgical Technologist, Operating Room Technician, etc.)
  3. Date of program completion

 

4

This position will require employees to work rotational assignments of "on-call" duty. When on-call, employees must be able to report to San Joaquin General Hospital's OR Department within 30 minutes of being contacted.

By selecting "yes", you are indicating that you understand that during your rotational assignment, you are required to report to the San Joaquin General Hospital's OR Department within 30 minutes of being contacted for on-call duty.

Yes No