Official SealSan Joaquin County Human Resources Division


#0621-RH1104-TM
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.

 

As a condition of employment, Staff Nurses assigned to this Unit must be able to take standby call on a rotational basis. While on call, nurses must possess the ability to return to the hospital within 30 minutes. Are you available to work in a position that has these requirements?

Yes, I understand that this position requires the ability to work rotating hours and take standby call. Should I be selected for the position, I have the ability to meet the 30 minute response requirement while on Standby Call duty.
No, I understand that this position requires the ability to work rotating hours and take standby call, however I am unable to meet the 30 minute response requirement for this unit.
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 registered nursing experience in an acute care hospital Operating Room?

Yes No
 

If yes, please describe your Operating Room nursing experience and 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 )

Yes No
5.

Do you possess National Certification (CNOR)?

Yes No
6.

Licenses and Certificates:

In order to qualify to work in the Operating Room Unit, you must have successfully completed the Hemodynamic Monitoring Class, Preceptor Class and ACLS certification. (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 Hemodynamic Monitoring Class
Yes, I have completed an approved Preceptor Class (or adult learning equivalent)
Yes, I currently have ACLS Certification
I have not completed any of the above mentioned courses/certification