Official SealSan Joaquin County Human Resources Division


#0319-RH6203-AC
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess at least one year paid work experience as a Physical Therapist in San Joaquin County?

Yes No
 

If you answered yes to question #1, identify your position title and your employment timeline.

2.

PATTERN II:

Do you possess at least two years of progressively responsible paid work experience as a licenced Physical Therapist performing diagnostic and therapeutic physical therapy techniques for a variety of disabling conditions.

Yes No
 

If you answered yes to question 2, identify the following:

  • Job title
  • Name of employer
  • Employment timetime
  • Duties/reponsibilites performed specifically experience performing diagnostic and therapeutic physical therapy
3.

Do you possess a current license as a Physical Therapist issued by the Physical Therapy Board of California (PTBOC)?

Yes No
 

If you answered yes to question #3, identify your current PTBOC issued Physical Therapist license and the expiration date.