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Supplemental Questionnaire

Last Name
First Name

 

All applicants are required to complete the Minimum Qualification Supplemental Questionnaire as part of the online application process.  Insufficient or non-responsive answers to the Supplemental Questionnaire may result in ineligibility, disqualification, or lower scores.

Responses to items on the Supplemental Questionnaire must be supported by the information provided on the application in order to receive appropriate credit.  Please provide a response to each question below to the best of your ability.  Please provide all information requested even of the information may appear redundant.   Do not write, “See application” or “See resume.”

All education and experience referenced in this questionnaire MUST also appear in the work history and/or in the education sections of your application.  A resume will not substitute for this supplemental questionnaire or for a completed application.

As a reminder, all qualifying education must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the education experience you are about to describe in the "Education History" section of your application, you will not receive credit for this education.

If you are copying an old application, please take the time to update your work history section before submitting your application. 

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1.

Please indicate the selection that best matches your HIGHEST education attainment.

I possess a Master's Degree
I possess a Baccalaureate Degree
I possess a Associate's Degree
I possess a High School Diploma
I possess none of the above
2.

I possess a Master’s Degree in Social Work accredited by the Council on Social Work Education (CSWE)

Yes No
3.

I possess a Master’s Degree from a two-year accredited college for university in the following areas:

Marriage and Family Counseling
Clinical Counseling
Mental Health Counseling
Addiction Counseling
Counseling Psychology
None of the above
4.

I possess one of the following License and Certifications Required for Public Conservator’s Specialty and Long Term Care Operations:

Possession of a valid Licensed Clinical Social Worker (LCSW) license issued by the California Board of Behavioral Sciences (BBS)
Current proof of registration as an Associate Social Worker (ASW) intern issued by the California Board of Behavioral Sciences (BBS)
Possession of a valid Marriage and Family Therapist (MFT) license issued by the California Board of Behavioral Sciences (BBS)
Current proof of registration as a valid Marriage and Family Therapist Intern (MFTI) issued by the California Board of Behavioral Sciences (BBS)
Possession of a valid Professional Clinical Counselor (LPCC) license issued by the California Board of Behavioral Sciences (BBS)
Current proof of registration as a Professional Clinical Counselor Intern (PCCI) issued by the California Board of Behavioral Sciences (BBS)
None of the above
5.

How many years of experience do you possess as a social service case manager in the behavioral health field providing inpatient or outpatient services?

I possess five (5) years or more experience as a social service case manager in the behavioral health field providing inpatient or outpatient services.
I possess four (4) years to four years and 11 months experience as a social service case manager in the behavioral health field providing inpatient or outpatient services.
I possess three (3) years to 3 years and 11 months experience as a social service case manager in the behavioral health field providing inpatient or outpatient services.
I possess two (2) years to 2 years and 11 months experience as a social service case manager in the behavioral health field providing inpatient or outpatient services.
I possess one (1) year to 1 year and 11 months experience as a social service case manager in the behavioral health field providing inpatient or outpatient services.
I possess less than one (1) year of experience as a social service case manager in the field of adult protective services,
I have no experience as a social service case manager in the field of adult protective services,

 

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All applicants are required to complete the Training and Experience Evaluation as part of the online application process.  Insufficient or non-responsive answers to the Training and Experience Evaluation may result in ineligibility, disqualification, or lower scores.

The purpose of this Training and Experience Evaluation is to determine whether you meet the required licensure and to determine your knowledge, skills and abilities in job-related areas that have been identified as critical for satisfactory performance in position 2944 Protective Service Supervisor.

The information provided should be consistent with the information on your application and is subject to verification. Verification of education and work experience may be collected at any time during or after the selection process.

Please follow these instructions when answering the questions below:

  • Provide your best or highest example of work.
  • Provide all information requested even if it may appear redundant. Do not write “see application” or “see resume.”
  • When requested, please supply the name of a person who can verify the information you provided about your specific experience. This should be a supervisor, program director or other individual who has personal knowledge that you performed such activities.
  • Please be thorough but concise. Your written communication skills will be evaluated based on your responses. All relevant experience, education and/or training must be included in the spaces provided in order to be reviewed in the rating process.
  • If no experience, type “none.”

Please choose the best answer for the questions below:


1.

Education

Possession of a Master’s Degree in Social Work from a school accredited by the Council on Social Work education (CSWE): OR, a Master’s Degree from a two-year (2) counseling program from an accredited college or university.(Qualifying Master’s Degrees in counseling include Marriage and Family Therapy, Clinical Counseling, Mental Health Counseling, Addiction Counseling and Counseling Psychology; AND

Experience

For Positions in Public Conservator and Long Term Care Operations
Two (2) years of experience as a social service case manager in the behavioral health field providing inpatient or outpatient services; AND

License and Certifications Required for Public Conservator’s Specialty and Long Term Care Operations:

a.Possession of a valid Licensed Clinical Social Worker (LCSW) license issued by the California Board of Behavioral Sciences (BBS) OR Current proof of registration as an Associate Social Worker (ASW) intern issued by the California Board of Behavioral Sciences (BBS); OR

b.Possession of a valid Marriage and Family Therapist (MFT) license issued by the California Board of Behavioral Sciences (BBS) OR Current proof of registration as a valid Marriage and Family Therapist Intern (MFTI) issued by the California Board of Behavioral Sciences (BBS); OR

c.Possession of a valid Professional Clinical Counselor (LPCC) license issued by the California Board of Behavioral Sciences (BBS) OR 
Current proof of registration as a Professional Clinical Counselor Intern (PCCI) issued by the California Board of Behavioral Sciences (BBS).

 

Yes No
1a.

If you answered “Yes” to Question 1 above, please provide your LCSW License number, your name as it appears on your LCSW License, and the expiration date of your LCSW License.

1b.

Please indicate all the employment settings that demonstrates where you acquired your clinical social work experience.  If no experience, then check “I have no experience in these areas.”

 

Community Mental Health Treatment Programs
Public Health
Psychiatric Hospitals
Veterans Administration
Private Hospitals
State Hospitals
Neuropsychology
Conservatorship Services
I have no experience in these areas
2.

Please identify the amount of verifiable work experience you have as an LCSW working in the area of conservatorship services.  If no experience, then check “I have no experience in these areas.”

Please note, 2,000 work hours equals to one year.

 

I have no experience in these areas.
I have 1 - 11 months of full-time equivalent work experience in these areas.
I have 12 - 23 months of full-time equivalent work experience in these areas.
I have 24 - 35 months of full-time equivalent work experience in these areas.
I have 36 - 59 months or more of full-time equivalent work experience in these areas.
I have 60 months or more of full-time equivalent work experience in these areas.
2b.

In accordance with your response to Question 2a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information.  If no experience, type “none.”

2a.

Please provide a brief description of verifiable work experience you have as an LCSW working in the area of conservatorship services.  Include in your answer your specific role and primary duties and responsibilities. If no experience, type “none.”

3.

Please identify the amount of verifiable work experience you have as an LCSW working with adults in community mental health treatment program, public health, psychiatric hospitals, Veterans Administration, private and/or State hospitals.  If no experience, then check “I have no experience in these areas.”

Please note, 2,000 work hours equals to one year.

I have no experience in these areas.
I have 1 - 11 months of full-time equivalent work experience in these areas.
I have 12 - 23 months of full-time equivalent work experience in these areas
I have 24 - 35 months of full-time equivalent work experience in these areas.
I have 36 - 59 months or more of full-time equivalent work experience in these areas.
I have 60 months or more of full-time equivalent work experience in these areas.
3a.

Please provide a brief description of verifiable LCSW experience working with adults in community mental health treatment program, public health, psychiatric hospitals, Veterans Administration, private and/or State hospitals.  Include in your answer your specific role and primary duties and responsibilities.  If no experience, type “none.”

3b.

In accordance with your response to Question 3a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information.  If no experience, type “none.”

4.

Please identify the amount of verifiable work experience you have preparing professional case or court report of findings and recommendations.  If no experience, then check “I have no experience in these areas.”

Please note, 2,000 work hours equals to one year.

I have no experience in these areas.
I have 1 - 11 months of full-time equivalent work experience in these areas.
I have 12 - 23 months of full-time equivalent work experience in these areas
I have 24 - 35 months of full-time equivalent work experience in these areas.
I have 36 - 59 months or more of full-time equivalent work experience in these areas.
I have 60 months or more of full-time equivalent work experience in these areas.
4a.

Please provide a brief description of the types of case or court report of findings and recommendations.  Include in your answer how you organized and implemented your findings and recommendations.  If no experience, type “none.”

4b.

In accordance with your response to Question 4a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information.  If no experience, type “none.”

5.

By checking this box, I hereby certify that I am the sole author of this supplemental application. I further acknowledge that all information provided is consistent with my employment application and is true and correct based on my education, training, skills, and/or experience. I understand that any false or incorrect statement may result in my disqualification from this and future examinations and/or dismissal from employment with the City and County of San Francisco. I also understand and agree to provide verification, when requested.