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Human Capital Management
#180726-H24A-11


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 a bachelor's degree?
Yes No

 

ATTENTION!

 Please verify that 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 purposes, in lieu of a written exam.


 

Check the box that represents your highest level of education.

I have a Master's degree in a field related to child care.
I have a Master's degree in a field unrelated to child care.
I have a Bachelor's degree in a field related to child care.
I have a Bachelor's degree in a field unrelated to child care.
I have none of the education listed above.
 

Please list the college or university where you gained your education as indicated in the response above.  If you indicated "no education", then please type N/A below. 

 

What experience do you have researching and gathering information?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 check all of the following areas in which you have taken college classes.

child development
early childhood education
child psychology
family, marriage, and child development
special education
interviewing techniques
investigative techniques
I have not taken classes in any of the areas listed above.
 

Please list the school and location where you gained your education as indicated in the response above.  If you indicated "no education", then please type N/A below. 

 

Please check all of the following computer programs you have experience using.

Microsoft Word or similar word processing software
Microsoft Excel or similar spreadsheet software
Microsoft PowerPoint or similar presentation software
Microsoft Outlook or similar email program
I have no experience with any of the above.
 

Please list the school and location or 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. 

 

 

What experience do you have using a computer to gather information and draft written documents?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have interpreting and implementing policies and procedures?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have with preparing and giving verbal presentations?

I have made verbal presentations as a regular part of my job.
I have made verbal presentations in a college course.
I have no experience with any of the above.
 

Please list the school and location or 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. 

 

What experience do you have planning, developing and organizing all phases of your own work?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have in mediation or conflict resolution?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What is your highest level of experience in working as part of a team?

I have led a team or group project.
I have been a member of a team or group project.
I have never been a member of a team or group project.
 

Please list the school and location or 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. 

 

What is your experience providing customer service to the public?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with 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. 
 

What experience do you have reading and interpreting detailed instructions?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have providing adults with consultation, training, and technical assistance?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have preparing written reports?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What is your experience with achieving multiple tasks with the same deadine?

I independently prioritize my tasks in order to achieve them by deadline.
I have prioritized my tasks in order to achieve them with guidance from my supervisor.
I have no experience with this task.
 

Please list the school and location or 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 check all of the following positions you have held in a child care-related setting.

Child care director
Family child care home primary provider
Child care master teacher
School teacher
Child care teacher
Family child care home assistant
I have not held any of the positions listed above.
 
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. 
 

What experience do you have coordinating with other agencies or departments to achieve a common goal?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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. 

 

What experience do you have with child care licensing requirements?

I have utilized child care licensing requirements independently as a regular part of my job.
I have utlized child care licensing requirements as a regular part of my job under supervision.
I am familiar with child care licensing requirements or have received some training on them.
I have no experience with child care licensing requirements.
 

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.