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
Please describe your full-time experience working in a clinical psychiatric-mental health setting. Be sure to provide the organization where you worked, duration of experience (employment dates), your title, your role and a description of your primary related responsibilities.
2
Please describe your experience collaborating and working with a multidisciplinary team (i.e. behavioral health professionals, agencies, consumers, clinicians, doctors, nurses, etc.) within a high-volume clinic and/or program providing services to consumers with serious behavioral health issues.
3
This classification requires current certification as a Nurse Practitioner by the Board of Registered Nursing in the State of California. In the space provided below, please provide your current valid certification number, and expiration dates.
4
I understand that, in compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as a condition of employment, employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job and I am able to meet this requirement.
Yes
No
5
I understand that, in compliance with Medicare regulations, employees in this classification are required to complete the “Medicare Enrollment Process for Physicians and non-Physician Practitioners” through the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services, prior to their first day on the job. Active enrollment in Medicare is a condition of employment. Failure to attain or maintain active enrollment will result in termination. I am able to meet this requirement.
Yes
No
6
I understand that possession of a current DEA (Drug Enforcement Administration) Registration Certificate/Number is required of employees in this classification and I am able to meet this requirement.
Yes
No
7
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.
Human Resource Services Department