The purpose of this Supplemental Questionnaire is to assist with evaluating possession of the Minimum Qualifications (i.e. required education/training, license, and registration) and Desirable Qualifications for 2242 Senior Psychiatric Physician Specialist positions.
If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with and supported by the information on your application (i.e. Education, Professional Licenses, Certifications, or Registrations & Employment Record sections) and are subject to verification at any time.
As a reminder, all qualifying education, licensure, registration, certification, and experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the education/training, license, registration, or experience you are about to describe in the applicable sections of your application, you will not receive credit. If you are copying an old application, please take the time to update applicable sections before submitting your application.
1a.
Please select the highest level of education that you have completed.
High School Diploma or equivalent
Associate's degree
Bachelor's degree
Master's degree
Doctoral degree
None of the above
1b.
Did you successfully complete a residency program accredited by the Accreditation Council for Graduate Medical Education or American Osteopathic Association in a Psychiatric medical specialty area?
Yes
No
1c.
If you answered "no" to #1b above, when will you successfully complete a residency program accredited by the Accreditation Council for Graduate Medical Education or American Osteopathic Association in a Psychiatric medical specialty area (e.g. MM/YYYY)? If you have already successfully completed a residency program in a Psychiatric medical specialty area, type N/A.
1d.
Did you successfully complete a fellowship program in Child and Adolescent Psychiatry?
Yes
No
1e.
If you answered "no" to #1d above, when will you successfully complete a fellowship program in Child and Adolescent Psychiatry? If you are not enrolled OR you have already successfully completed a fellowship program in Child and Adolescent Psychiatry, type N/A.
2a.
Do you have a valid license to practice medicine issued by the Medical Board of California or the Osteopathic Medical Board of California?
I have a valid license to practice medicine, but it is issued by another state within the United States of America (i.e. not California)
I have a valid license to practice medicine issued by the Medical Board of California
I have a valid license to practice medicine issued by the Osteopathic Medical Board of California
None of the above
2b.
Do you have valid Drug Enforcement Administration (DEA) registration with the United States Department of Justice?
Yes
No
3.
Do you have valid board certification in a Psychiatric medical specialty area OR are you eligible for valid board certification in a Psychiatric medical specialty area?
I am not eligible for valid board certification in a Psychiatric medical specialty area
I am eligible for valid board certification in a Psychiatric medical specialty area
I have valid board certification in a Psychiatric medical specialty area
None of the above
4.
How much post-residency experience do you have as a practicing Physician in a Psychiatric medical specialty area?
One (1) year of full-time experience is equivalent to 2,000 hours.
I have less than one (1) year of this experience
I have at least one (1) year, but less than two (2) years of this experience
I have at least two (2) years, but less than three (3) years of this experience
I have at least three (3) years, but less than four (4) years of this experience
I have at least four (4) years, but less than five (5) years of this experience
I have five (5) years or more of this experience
I do not have any of this experience
5.
Please identify all San Francisco Health Network BEHAVIORAL HEALTH SERVICES DIVISION clinic/location/program(s) for which you'd like to be considered. Select all that apply.
Mental Health Rehabilitation Center/ZSFG
Central City Older Adult Services
Chinatown Child Development Center
Chinatown North Beach Clinic - MH
Community Behavioral Health Services
Comprehensive Crisis Services
Family Mosaic Project
Foster Care Mental Health Program
HIV and Gender Services
Laguna Honda Hospital and Rehabilitation Center
Mission Family Center
Mission Mental Health/Mission Act
OMI (Ocean Merced Ingleside Health Center)
SF First
South of Market Mental Health Center
Southeast Child Family Therapy Center
Southeast Mission Geriatric Services
Substance Use Disorder Services
Sunset Mental Health Services
Transitional Age Youth Services
Primary Care Consultation
None of the above
CONDITIONS OF EMPLOYMENT:
I understand that I can apply if my valid license to practice medicine is issued from another state within the United States of America (i.e. not California), but if selected, I will not be appointed/hired until I obtain a valid license to practice medicine issued by the Medical Board of California or the Osteopathic Medical Board of California and it must remain valid throughout the duration of employment.
I understand that I can apply if I am still enrolled in a residency program, but if selected, I will not be appointed/hired until I demonstrate successful completion of a residency program accredited by the Accreditation Council for Graduate Medical Education or American Osteopathic Association in a Psychiatric medical specialty area (see #1c above).
CERTIFICATION: I understand that checking this box will serve as my electronic signature. I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience. I understand and agree that any information provided is subject to verification. I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.
Department of Human Resources