offical seal
Human Capital Management
#180601-F78B-02


Supplemental Questionnaire

Last Name First Name
 

 

OK Department of Human Services (DHS) requires that the following questions be answered before continuing with the application.


1.

Do you have legal status to work in the United States?

Yes No
2.

Have you had a protective order entered against you pursuant to the Oklahoma
Protection from Domestic Abuse Act or a similar statute of another state? 

If yes, provide the name of the court and court number in the text area:

If no, please enter No in the text area:            

3.

DHS policy does not allow some family members to be employed within the same supervisory group or unit. Please list the names of all of your relatives now employed by DHS:

If no, please enter No in the text area:

4.

Have you ever been terminated or resigned from employment in lieu of being terminated?  
If yes, explain circumstances:      

If no, please enter No in the text area:

 
Do you have any of the following?
two (2) years of experience operating and maintaining medium to heavy power equipment
sixty (60) semester hours of college coursework
a combination of experience operating and maintaining medium to heavy power equipment AND college coursework that totals two (2) years
none of the above

 
STOP! You have completed the required screening questions for this Job Family.  Please verify you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire. The questions below will be used for scoring in lieu of a written exam.

1.
What is your experience in operating a dozer?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

2.
What is your experience in operating a motor grader?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

3.
What is your experience in operating a tractor-trailer transport?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
4.
What experience do you have in operating a tractor with attachments such as a brush hog, roller, or disc?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

5.
What is your experience in operating a backhoe?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

6.
What is your experience in operating a front-end loader?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
7.
What is your experience in operating a forklift?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
8.
What is the longest route you have driven a tractor-trailer as a regular part of your job?
I have driven a tractor-trailer across states.
I have driven a tractor-trailer in town.
I have not driven a tractor-trailer as a regular part of my job.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

9.
What is the largest group of heavy equipment operators that you have supervised in planning projects and/or implementing projects as a regular part of your job?
I have supervised a crew.
I have supervised a division.
I have not supervised in planning projects and/or implementing projects for heavy equipment operators as a regular part of my job.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
10.
What is your experience in planning routes as a tractor-trailer driver?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
11.
What is your experience in doing preventative or routine maintenance on heavy equipment?
I have performed this task as a regular part of my job.
I am familiar with this task or have received some training in it.
I have no experience or training in the performance of this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

Please make sure that you attach all requested documents to your application, if requested.  Resumes should be attached to the "Resume" tab and any other requested documents to the "Other" tab.