Official SealHuman Resource Services Department


#17-0305-05
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.

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
1

Do you possess a Master’s degree in social, behavioral, or health sciences AND three years of experience providing direct mental health and/or alcohol and other drug services to adults in a clinical setting?

Yes No
2

If you answered yes, please describe your experience providing direct mental health and/or alcohol and other drug services to adults in a clinical setting. In your response, include your job title, role, length of experience (dates), the agency where you gained such experience, and the specific services you rendered.

If you answered no, type "N/A"

3

Please describe your full-time supervisory work experience, if any, in the direct delivery of services to clients or the oversight of such services. In your response, please specify your role, length of experience (dates), and the agency you worked for.

4

Please describe your experience with the items below. In your response, please be specific about your role, dates of employment, and the agency you worked for:

  • administering, planning, monitoring and/or evaluating programs (include the types of programs)
  • contract negotiations
  • grants management and similar financial services
  • managing diverse stakeholders
5

In your experience planning, monitoring and/or evaluating programs, describe one situation where you identified and helped to resolve a significant problem. What was the problem? How did you identify it? What were the steps you took to resolve this problem? What was the outcome?

6

Describe one situation/project in which you developed and maintained good working relationships with both internal and external partners, while also holding those partners accountable for major deliverables that were needed to ensure the success of the situation/project. What were the strategies you used? What was the outcome?

7

In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job. Can you meet this criteria?

Yes No

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