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#0721-RH0300-01
Supplemental Questionnaire

Last Name
First Name
1.

In order to qualify for the Patient Services Representative position, you must meet one of the below minimum qualifications pattern.  Please select below which pattern you are qualifying under. 

Pattern I: I possess one year experience as an Eligibility Worker I in San Joaquin County.
Pattern II: I possess 60 semester units from an accredited college or university with major in liberal arts, business administration, social science, or closely related field AND one year of experience in credit or eligibility interviewing, or other comparable interviewing.
Pattern III: I possess four years of office clerical experience involving extensive public contact, two years of which must have been equivalent to an Office Assistant or higher class in San Joaquin County Service.
None of the above.
2.

If you are qualifying under Pattern I: One year of experience as an Eligibility Worker I in San Joaquin County service, please answer the following.  If you are not, please indicate "n/a" below.

What are your employment dates and hours worked per week in your position as Eligibility Worker I in San Joaquin County? This information may be verified.

Please provide brief description of your experience and responsibility area(s) of eligibility determination. 

3.

If you are qualifying under Pattern II: Completion of 60 semester units from an accredited college or university with a major in liberal arts, business administration, social science, or closely related field AND one year of experience in credit or eligibility interviewing, or other comparable interviewing, please answer the below questions. If you are not qualifying under this pattern, indicate "n/a" below.

A.  Education:  Indicate the highest level of education received. In your response, include: 1) Name of college or university, 2) Type of degree obtained or if the degree is not received, indicate the number of units completed and 3) Major area of study.

B.  Experience:  Describe your experience conducting credit or eligibility interviewing.  What services or programs were you determining eligibility for?  Who were your customers or clients and why did they come to you for services. Include in your response what paperwork was involved and what eligibility tools did you use to determine your customers' or clients' eligibility for a service or program.  Note: When providing examples of your work experience, please cite the job where the experience was obtained.

4.

If you are qualifying under Pattern III: Four years of office clerical experience involving extensive public contact, two years must be equivalent to an Office Assistant or higher class in San Joaquin County Service, please answer the below questions. If you not qualifying under this pattern, indicate "n/a" below.

Describe your office clerical experience involving extensive public contact.  Include in your response, who from the public are your customers, and what services were you responsible for providing. Include in your answer an estimated number of customers you serve on a daily basis.  Note: When providing examples of your work experience, please cite the job where the experience was obtained.

5.

This eligible list may also be utilized to fill Part-Time or Temporary Patient Service Representative positions with San Joaquin General Hospital. Please read the following options below to indicate if you would also like to be considered for Part-time or Temporary Patient Service Representative employment opportunities.

Yes, I would like to be referred for Part-time Patient Service Representive opportunities.
Yes, I would be like to be referred for Temporary Patient Service Representative opportunities.
No, I would not like to be referred for Part-time or Temporary Patient Service Representative employment opportunities. I am only interested in full-time employment.