Department of Human Resources

2324 NURSE SUPERVISOR
SPECIALTY: Jail Health Services
SUPPLEMENTAL QUESTIONNAIRE

The purpose of this Supplemental Questionnaire is to determine if you meet the Minimum Qualifications of a 2324 Nurse Supervisor Jail Health Services specialty, and to determine your knowledge, skills, and abilities in job-related areas that have been identified as critical for satisfactory performance in this specialty.

Responses to supplemental questionnaire items must be supported by the information provided in the body of your application (i.e. education and training/employment record section) in order to receive appropriate credit, and are subject to verification. Verification of experience, licensure, and possession of valid certifications/certificates may be collected at any time during or after the selection process.

INSTRUCTIONS: Please answer all applicable questions by choosing the best response that matches your education, experience, certifications, licenses, and/or by providing the information requested.

What is the highest degree you have obtained in Nursing?

Please list the school where you obtained your degree in Nursing. If you do not possess any of the degrees identified above, type N/A.

Please identify the highest graduate level degree that you possess from the list of disciplines below. If you do not have a graduate level degree in these disciplines, please select "None of the above." 

Do you possess a valid California Registered Nurse license issued by the California Board of Registered Nursing?

If you answered “Yes” to #2a above, please provide your California Registered Nurse license number, your name as it appears on your Registered Nurse license, and the expiration date of your license.  If you answered “No” to question #2a above, please provide an explanation below.

Do you have a valid Cardiopulmonary Resuscitation (CPR) certificate issued by the American Heart Association (AHA)?

If you answered “Yes” to #3a above, please identify all of the valid AHA CPR certificates that you possess. 

Please provide your name, Certificate number, and the expiration date for each of the AHA CPR Certificates you selected in Question 3a. If you answered "None" or "Other" to question 3a., please provide an explanation.

How much verifiable full-time equivalent experience do you have in a designated Nursing supervisory capacity (nurse manger or designated charge nurse) or administrative leadership/support role, in a Medical-Surgical, Critical Care, Perioperative, Emergency, Psychiatry, Perinatal, or similar inpatient unit in an acute care hospital (a hospital which provides 24 hour inpatient care, including the following basic services: Medical, Nursing, Surgical, Anesthesia, Laboratory, Radiology, Pharmacy and Dietary Services)? (Full-time experience is equivalent to 40 hours per week.)

In accordance with your response to #4a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the verifiable full-time equivalent work experience.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information.  Do not type - See Resume. If you do not have experience in these areas, please type N/A.

In accordance with your responses to #4a and #4b above, please provide a brief description of your qualifying work experience and include in your answer your specific role and primary duties and responsibilities. Do not type - See Resume. If you do not have experience in these areas, please type N/A.

In accordance with your response to #4a above, how many employees do you have experience supervising?  Relevant supervisory experience should include, but not be limited to staff development, performance evaluation, and disciplinary processes. 

Do you have knowledge and experience in the application of the following federal and state regulatory and/or accreditation standards?  If yes, please select all that apply.