Official SealSan Joaquin County Human Resources Division


#0722-RH1105-AC
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. Are you available to work in a position that has these requirements?

Yes No
2.

Licenses & Certificates:

Are you currently licensed as a registered nurse in the State of California?

Yes No
 

If yes, please list the license number and expiration date.

3.

Do you possess a Bachelor’s Degree in Nursing? (Please Note: If yes, be sure to clearly identify your degree either on the education portion of your employment application or resume as it will be source verified).

 

Yes No
4.

Do you possess nursing National Certification?(A copy of your certification must be submitted with employment application in order to be considered)

Yes No
5.

Licenses and Certificates:

In order to qualify for this position you must have successfully completed a Fetal Heart Monitoring Class, Advanced Fetal Heart Monitoring Class, Neonatal Resuscitation Class, and Preceptor Class. (Please note that 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 Fetal Heart Monitoring Class
Yes, I have completed an approved Advanced Fetal Heart Monitoring Class
Yes, I have completed an approved Neonatal Resuscitation Class
Yes, I have completed an approved Preceptor Class (or adult educator/trainer equivalent)
I have not completed any of the above mentioned courses/certification
6.

Do you possess two (2) years of registered nurse experience in an acute care Family Maternity Center?

Yes No