Last Name | |
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First Name |
1. License: Are you currently registered as a nurse in the State of California? |
Yes No |
If yes, please identify your license number and expiration date: (Note: A copy of your license needs to be submitted with your application. You may send it via email to humanresources@sjgov.org, fax to 209-468-0508, or to Human Resources, 44 N San Joaquin, Ste 330, Stockton 95202) |
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2. If you responded no, do you have possession of an interim permit issued by the State of California Board of Registered Nursing? |
Yes No |
If yes, please identify your interim permit number: |
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3. Experience: Do you possess 6 months of experience as a registered nurse in an acute care or mental health facility? |
Yes No |
If yes, please identify your employer (acute care or mental health facility), your title, responsibilities and duties, dates of employment, and hours worked per week: |
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4. Substitution: Possession of a bachelor's degree in nursing may be substituted for the required experience. Do you possess a bachelor's degree in nursing? (If yes, please make sure it is clearly identified on your employment application under education or resume). |
Yes No |
If yes, please list the name of the college and/or university you obtained your BSN from: |
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