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Human Capital Management
#180809-F78C-01


Supplemental Questionnaire

Last Name First Name
 

 

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


 

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

Yes No
 

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:            

 

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:

 

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 three years of experience in operating and maintaining power equipment used in maintenance, construction or transportation?

Yes No

 
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 supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

2.

What is your level of expertise operating a dozer?

I am considered a finish dozer operator.
I am considered a rough dozer operator.
I have no experience operating a dozer.
 

Please list the school 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. 

3.

What is your experience in operating a motor grader?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

4.

Please check all of the following trailers with which you have experience.

Van trailer
Rock trailer
Light-duty equipment trailer
Lowboy trailer
I have no experience with any of these types of trailers.
 

Please list the school 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. 

5.

What experience do you have in operating a tractor with attachments (e.g., brush hog, roller, disc)?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

6.

What is your experience in operating a backhoe?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

7.

What is your experience in operating a front-end loader?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

8.

What is your experience in operating a forklift?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

9.

What is your experience driving a tractor-trailer?  Check all that apply.

I have driven a tractor trailer on two-lane highways.
I have driven a tractor-trailer off roads.
I have driven a tractor-trailer on city streets.
I have driven a tractor-trailer on the Interstate.
I have not driven a tractor-trailer as a regular part of my job.
 

Please list the school 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. 

10.

What is your experience in planning routes as a tractor-trailer driver?

I have supervised others performing this task.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the school 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. 

11.

What is your experience in doing preventative or routine maintenance on heavy equipment?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

12.

What is your experience securing equipment for transport?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

13.

What is your experience unloading and loading heavy equipment, equipment, or supplies?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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. 

14.

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 school 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. 

15.

What is your experience laying out a job or interpreting blueprints?

I have supervised others performing this task.
I am considered an expert at this task and have performed it as a regular part of my job. Other workers ask me to assist on this task because of my experience.
I have performed this task as a regular part of my job. My work was subject only to general review by a supervisor or senior employee.
I have had training in this task, but I have not performed this type of task as a regular part of my job.
I have not had training or experience in performing this task.
 

Please list the school 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.