Official SealSan Joaquin County Human Resources Division


#0621-TH9258-TM
Supplemental Questionnaire

Last Name
First Name

 

NoteA copy of your unofficial transcript demonstrating a grade of "C" or better must be submitted by the final filing date. The transcript may be submitted by:

  • Attaching it to your online application when prompted for a resume
  • Mailing to: San Joaquin County Human Resources, 44 N San Joaquin St., Ste 330, Stockton, CA 95202
  • Hand delivering to: San Joaquin General Hospital Human Resources, Room 1407, 500 W Hospital Rd. , French Camp, CA 95231
  • Faxing to: (209) 468-6271

1

Current enrollment in an approved Registered Nurse curriculum is required. Please identify the semester in which you are currently enrolled:

First semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Second semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Third semester of an approved Registered Nurse curriculum with a grade average of "C" or better.
Fourth and final semester of an approved two-year registered nurse curriculum OR in subsequent semesters of a Registered Nurse baccalaureate program with a grade average of "C" or better.
I am not enrolled in an approved Registered Nurse curriculum.
2

Please indicate if you possess full-time paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.

Yes, I have six months (1040 hours worked) of full-time paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
Yes, I have one year (2080 hours worked) of full-time paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
Yes, I have eighteen months (3120 hours worked) of full-time paid work experience performing duties equivalent to those of a nursing aide in an acute care facility.
No, I do not have any paid work experience performing duties equivalent to a nursing aide in an acute care facility.
3

If you possess the required experience, please provide a description of the typical duties you performed that were equivalent to those of a nursing aide in an acute care facilityInclude the following information:

  1. Job Title
  2. Name of Employer/Acute Care Hospital
  3. Dates of Employment (from/to)
  4. Number of hours worked per week