Official SealHuman Resource Services Department


#17-5525-01
Supplemental Questionnaire

Last Name
First Name
 

Applicants for this position are required to submit responses to the following supplemental questions.  Your completed responses to the supplemental questionnaire will be evaluated to determine your qualifications and must be completed properly in order to be given full consideration for the next phase in the selection process. Additionally, your responses will also be evaluated and used in the selection process in order to identify the best qualified applicants.

Responses should be thorough and specific.  A lack of detail and explanation in the supplemental questions and in your application may result in failure or disqualification for this position.  Clarity of expression, content, experience, grammar, spelling and the ability to follow instructions will be considered in the evaluation process.  A resume will not be accepted as a substitute for properly completed responses.

Information provided in your responses to the supplemental questionnaire regarding your employment experiences must also be detailed in the Work Experience section of the application for this recruitment.  Please be sure to list all employers and required information, on your application, especially if you are referencing those employers in your responses to the supplemental questions.

By selecting yes below, you certify your understanding that all applicants must submit a complete application and complete responses to the supplemental questions in order to be considered for this recruitment. Do you understand the above statement?

Yes No
1.

This position requires possession of a master’s degree in public health from an accredited university with a specialization in administration, epidemiology, health policy and planning, maternal and child health or health education.

Do you meet this requirement?

Yes No
2.

This position requires the equivalent of five years of full-time experience in a state or local public health dental program, or other public or private dental health setting. At least three years of this experience should have been in an administrative and supervisory capacity.

Do you meet this requirement?

Yes No
3.

This position requires possession of a valid license to practice dentistry in the state of California.

Do you meet this requirement?

Yes No
 

If you answered 'yes' above, please provide your license number in the space below.  

4.

Please describe the work experience you possess in a public health dental program. In your response, please detail your specific role, services you were responsible for delivering, any administrative duties you were responsible for, including grants management, dates of employement and employer where you performed these duties.

5.

Please describe your experience planning, implementing and evaluating an innovative public health dental program which provided services for underserved populations in the community.

6.

Please describe your experience facilitating partnership with diverse community stakeholders, including community-based organizations and residents' engagement, in order to develop, or further, dental health programs.

7.

Please describe your experience developing and implementing policies and protocols to ensure compliance with legislative mandates, minimum standards and state and federal rules and regulations associated with public health dental programs.

8.

Please describe your experience as a supervisor either in your current or previous role(s). In your response explain how you provided support and guidance to your direct reports, what you found to be the most effective as well as what you found to be the most challenging in providing support and guidance to your staff. What did you do to overcome the challenges?

9.

Please describe your experience developing, managing and administering program budgets, and coordinating fiscal, personnel and contract activities based on organizational goals, objectives, and priorities. In your response, include the employer where you gained the experience, dates of employment, your role, and a description of your related responsibilities.

 

The supplemental questions were designed to elicit your experience as it relates to the current recruitment in order to identify the best qualified candidates for this position. Only the best and most suitably qualified candidates will be invited to participate in the oral interviews.

By selecting yes below, you certify your understanding that all applicants who meet minimum qualifications are not guaranteed to move forward in the process. Do you understand the above statement?

Yes No

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