Official SealSan Joaquin County Human Resources Division


#1123-RC2040-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid California Driver's License?

Yes No
 

If yes, provide the license number and expiration date (MM//DD/YYYY)

2.

In the space provided below, please detail your paid work experience performing general warehouse, housekeeping, laundry, landscaping/horticultural or related duties in a large commercial or institutional facility. Include name of employer, job title, dates of employment, average hours worked per week, and a detailed description of the specific duties you performed.

3.

In the space provided below, please detail your paid experience in general office clerical work. Include name of employer, job title, dates of employment, average hours worked per week, and a detailed description of the specific duties you performed.

4.

SUBSTITUTION: Completion of 30 semester/45 quarter units at an accredited college, university, or approved vocational/technical school may substitute for the above-required experience on a year for year basis, where 30 semester units is equivalent to one year.

If applicable, list the total number of units completed and the school from which they were obtained: