Official SealSan Joaquin County Human Resources Division


#0522-RH1104-A1
Supplemental Questionnaire

Last Name
First Name
1.

San Joaquin General Hospital is a 24/7 running facility. Employees are expected to be open to working rotating shifts that will include nights, weekends and holidays. Employees in this Unit are also expected to work mandatory "On-Call" shifts on a rotating basis. Are you available to work in a position that has these requirements?

Yes No
2.

Are you currently licensed as a Registered Nurse with the State of California?

Yes No
 

If yes, please provide your license number below:

3.
Do you possess two (2) years of paid registered nursing experience in a Post Anesthesia Care Unit (PACU)?
Yes No
 

If yes, please describe your PACU duties below. Please include: Name of Employer, Job Title, dates of employment and hours per week worked.

4.

Do you possess a Bachelor’s Degree in Nursing?(Note that if yes, you must clearly include on your employment application or resume and may be substituted for one (1) year of the required experience)

Yes No
5.

Do you possess National Certification?

Yes No
6.

Licenses and Certificates:

In order to qualify to work in the PACU, you must have successfully completed the Hemodynamic Monitoring Class, PALS, Preceptor Class and ACLS certification. NOTE: Proof of completion must be submitted with your employment application in order to be considered. Please check all that apply below:

Yes, I have completed an approved Hemodynamic Monitoring Class
Yes, I have completed an approved Preceptor Class (or adult learning equivalent)
Yes, I have completed an approved PALS Class
Yes, I currently have ACLS Certification
I have not completed any of the above mentioned courses/certification