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Senior Supplemental

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					                                 Physical Therapist III - Senior
                                   Supplemental Application
                                       RH6203-0508-TM

Name:                                            SSN:

 Please complete this supplemental application and attach it to the standard application. This
  information is part of your official application and may be verified. You may use additional
                  sheets of paper to complete the supplemental application.

San Joaquin General Hospital utilizes part time and per diem Physical Therapist III - Senior
positions to meet variable workload needs.

1. Are you interested in full time Physical Therapist III - Senior positions only?

   Yes

We are not currently recruiting for full time positions for this position. If you would like to be
notified when full time recruitment is open, please contact 468-3370 for an interest card, which
you may complete and return to San Joaquin County Human Resources Division, 106 S
Hunter Street, Room 106. Stockton, CA 95202



2. Are you interested in part time or per diem Physical Therapist III - Senior positions only?

   No

We are not currently recruiting for full time positions for this position. If you would like to be
notified when full time recruitment is open, please contact 468-3370 for an interest card, which
you may complete and return to San Joaquin County Human Resources Division, 106 S
Hunter Street, Room 106. Stockton, CA 95202

   Yes

If you answered yes, continue application below.



Do you have two years of experience as a licensed physical therapist?

   Yes

Do you possess and maintain a California license as an Physical Therapist issued by the
State of California?

   Yes, I possess the appropriate valid license.

If you possess the required license, please enter the information below:
                                   Physical Therapist III - Senior
                                     Supplemental Application
                                         RH6203-0508-TM


License Number:

Expiration date of your license:




   No, I do not possess the appropriate valid license.

If you do not possess the license and/or experience indicated above, you will not meet the
minimum qualifications for this position. If you are in the process of obtaining the required
license, please check the box below.

   Yes, I am applying for licensure.