Official SealHuman Resource Services Department


#21-6214-01
Supplemental Questionnaire

Last Name
First Name
1.

Thank you for your interest in the position of Juvenile Institutional Officer Associate, Exam #21-6214-01. 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. 

By selecting yes below, you certify your understanding that all applicants must meet minimum qualifications in order to move forward in the process. 

Do you understand the above statement?

Yes No
2.

Are you 21 years of age or older?

Yes No
3.

Did you graduate from high school, attain a satisfactory score on a G.E.D. test, or pass a California High School proficiency examination?

Yes No
4.

Are you a citizen of the United States, or a permanent resident alien who is eligible for, and has applied for, citizenship?

Yes No
5.

Do you currently work, or have you previously worked, as a Juvenile Institutional Officer Intermittent for at least six months in the Alameda County classified service?

Yes No
6.

Do you possess the equivalent of one year of full-time experience involving the organization, direction, or supervision of youth groups in correctional counseling, or in a recreational or correctional setting?

If you answer "yes" to this question, please ensure that your experience is clearly outlined in your application. Simply checking "yes" to this question, and/or only including this information on your supplemental questionnaire, will NOT substitute for a properly/completely filled out application, and will result in disqualification.

Yes No
7.

Please list successfully completed college coursework that may be expected to provide the knowledge and skills required for this position. List each course individually, and include the school, course title, and number of units. In order to meet the educational minimum qualification, these courses must be equal to or greater than 30 semester, or 45 quarter, units. Coursework in the field of social sciences is highly desirable.

8.

Do you possess a valid California Driver's License? If yes, please ensure this information is indicated on your application.

Yes No
9.

Juvenile Institutional Officer Associates may be assigned to work day, evening and rotating shifts, including weekends and holidays. I understand that I may be assigned, and must be available to work, any shift.

Yes No
10.

I understand that a thorough background investigation will be conducted on all prospective Juvenile Institutional Officers to ensure they are suitable for work within a 24-hour Juvenile Probation facility.

Yes No
11.

Are you on probation/parole?

Yes No
12.

Have you ever been the subject of an emergency protective order/restraining order/stay-away order?

Yes No
 

If yes, please provide the date the emergency protective order/restraining order/stay-away order was issued (mm/dd/yyyy).

If you answered no, please enter "N/A".

13.

Have you ever fraudulently received welfare, unemployment compensation, workers’ compensation, or other state or federal assistance?

Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).

If you answered no, please enter "N/A".

14.

Have you ever sold, released, or given away any confidential information?

Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).

If you answered no, please enter "N/A".

15.

Are you a member or associate of a criminal enterprise, street gang, or any other group that advocates violence against individuals because of their race, religion, political affiliation, ethnic origin, nationality, gender, sexual preference or disability?

Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).

If you answered no, please enter "N/A".

16.

Have you ever filed a false insurance or workers’ compensation claim?

Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).

If you answered no, please enter "N/A".

17.

Have you ever committed a crime(s) for which you have NOT been arrested for?

Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).

If you answered no, please enter "N/A".


 

IMPORTANT: At any time in your life, have you EVER committed any of the following acts? (NOTE: You may NOT withhold any information regarding your involvement in any of the following acts, even if federal or state law relieved you from reporting the detention, arrest, or conviction that arose from it.)


18.

Murder, homicide, attempted murder or assault with the intent to commit murder.

Yes No
19.

Arson.

Yes No
20.

Assault with a deadly weapon.

Yes No
21.

Child abuse or molestation.

Yes No
22.

Forcible rape/Illegal sex acts.

Yes No
23.

Hate crime.

Yes No
24.

Perjury (lying under oath).

Yes No
25.

Elder abuse (physical and/or financial).

Yes No
26.

Possession of an explosive/destructive device.

Yes No
27.

Robbery (theft from another person using a weapon, force, or fear).

Yes No
28.

Domestic violence.

Yes No
29.

Kidnapping.

Yes No
30.

Embezzlement.

Yes No
31.

Manufacture/Cultivation of a controlled substance.

Yes No

 

IMPORTANT: Have you ever used or experimented with any of the drugs listed below? This includes the unauthorized or illegal use of prescription medications. If you answered yes, please give the most recent date used (mm/dd/yyyy).

Your response should include but not be limited to your use of the following:


32.

Amphetamines/Methamphetamines (Uppers, Speed, Crank etc.).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

33.

Barbiturates (Downers).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

34.

Cocaine/Crack Cocaine.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

35.

Designer Drugs (Ecstasy, Synthetic Heroin, etc.).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

36.

GHB (Date Rape Drug).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

37.

Hallucinogens (Peyote, LSD, Mushrooms).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

38.

Hashish/Hashish Oil.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

39.

Heroin/Opium.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

40.

Marijuana.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

41.

Mescaline.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

42.

Morphine.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

43.

PCP/Angel Dust.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

44.

Quaaludes.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

45.

Steroids.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

46.

Tetrahydrocannabinal (THC).

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

47.

Glue, paint, or any substance containing Toluene.

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".

48.

Have you used any illegal drugs that is not included in this list?

Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).

If you answered no, please enter "N/A".