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Human Capital Management
#180910-H21A-20


Supplemental Questionnaire

Last Name First Name
 

 
*For purposes of the Case Manager Job Family, "a bachelor's degree in a human services field" includes any degree from an accredited college or university, except for a degree in a physical, natural or biological science or mathematics.

 

Do you have any of the following?

a bachelor's degree in a human services field* AND one year of experience working directly with persons with intellectual disabilities
possession of a valid permanent Oklahoma license as approved by the Oklahoma Board of Nursing to practice professional nursing AND one year of experience working directly with persons with intellectual disabilities
none of the above

 

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:


 
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 experience do you have managing caseloads?

I have performed this task as a regular part of my job.
I am familiar with this task or have received some training 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. 

2.

What experience do you have providing services to disabled adults, children, and their families?

I have performed this task as a regular part of my job.
I am familiar with this task or have received some training 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. 

3.

Do you have experience advocating for what services, situations, etc. are best for a person who has intellectual disabilities or other challenges?

Yes No
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you have this experience but not from a paid job, please briefly describe the situation.  If you indicated "no experience", then please type N/A below.

4.

Do you have experience facilitating or leading meetings?

I have performed this task as a regular part of my job.
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. 

5.

What experience do you have developing and/or modifying a plan of care?

Performing this task was a major part of my job.
Performing this task was a minor part of my job duties.
Performing this task was not part of my job duties.
 

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 experience do you have implementing or monitoring a plan of care for a desired outcome?

Performing this task was a major part of my job.
Performing this task was a minor part of my job duties.
Performing this task was not part of my job duties.
 
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 identifying the needs of persons with intellectual disabilities?

I have performed this task independently as a regular part of my job.
I have performed this task with assistance or as part of a team.
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. 
8.

Do you have experience coordinating services with contracted providers (making referrals)?

I have performed this task as a regular part of my job.
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. 

9.

What experience do you have working with community resources such as food, clothing, or utility assistance, or low cost/free medical or dental services?  (Check all that apply.)

I have no experience with this task.
I have researched and identified community resources.
I have provided this information to clients.
I have assisted clients in obtaining services from these resources.
 
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.