Official SealHuman Resource Services Department

Supplemental Questionnaire

Last Name
First Name

Thank you for your interest in the Youth and Family Services Lead Therapist recruitment, Examination #23-6499-01. 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 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 to identify the best-qualified

Responses should be thorough and specific. A lack of detail and explanation in the supplemental questions and 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 the 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 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 the minimum qualifications are not guaranteed to move forward in the process.

Do you understand the above statement?

Yes No

Do you possess a master's or doctoral degree from an accredited college or university in social work, marriage and family therapy, clinical psychology, counseling, or a closely related field?

Yes No

If yes, please list the degree you possess and the accredited college or university you obtained the degree from.


Do you possess the equivalent of two (2) years of full-time post-licensure experience working as a mental health/behavioral health clinician, providing clinical counseling and/or case management services in a law enforcement, outpatient facility, hospital or other clinical or agency setting?

Note:  Previous experience involving lead or supervisory responsibilities is desirable.

Yes No

Do you possess a valid clinical license in Marriage Family Therapy (LMFT), Licensed Clinical Social Work (LCSW), Clinical Psychology, or Licensed Professional Clinical Counselor (LPCC), issued by the applicable licensing authority:  California Board of Behavioral Sciences or California Board of Psychology?

Note:  Licensing information should be reflected under the "Professional Credentials" section of your application.

Yes No

Please describe your experience providing clinical and administrative supervisory or lead responsibilities to subordinate staff activities and daily clinical/programmatic operations.  In your response, also include your experience overseeing subordinate staff seeking professional licensure.


Please describe your experience in providing crisis intervention, psychotherapy, case management, and referral services to diverse populations.


Please describe your experience working in a law enforcement or corrections environment.  In your response, indicate the position you held and your role within the structured unit.  In describing your experience, include the most challenging aspect met while working in that environment.


Please describe your proficiency with computer-based applications and software.  In your response, include specific applications you are well versed in and how you have used them to be most effective in your previous or current positions.  Be sure to include the types of tasks you used these applications for.


Do you have experience in billing services including Medi-Cal, private insurance, and/or Medi-Cal Administrative Activities (MAA)?

Yes No

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