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#TEX-2303-904364
Supplemental Questionnaire

Last Name
First Name

 

INSTRUCTIONS: The purpose of this Minimum Qualification Supplemental Questionnaire is to assess whether the applicant meets the minimum qualifications for this position. The information you provide to the following questions does not substitute for the online application, and must be consistent with and supported by the information listed on your application. You must still complete all sections of the online application. Please be sure to update all sections of your application prior to submission.

All information provided is subject to verification. Please do not write, "See Application" or "See Resume" as a response.


1.

Do you possess a valid and current Patient Care Assistant Certificate issued by the State of California Department of Health Services?

As a reminder, please include your certificate in the "Professional Licenses/Certifications/Registrations" section of your application, in order to receive credit for this certificate. If you are copying an old application, please take the time to update the Professional Licenses/Certifications/Registrations section of your application before submitting your application.

 

Yes No
2.

How much verifiable full-time equivalent work experience do you have as a health care worker within the last five (5) years working in a health care setting? (Full-time experience is equivalent to 40 hours per week.)

As a reminder, please include all work experience in the "Employment Record" section of your application in order to receive credit for this work experience. If you are copying an old application, please take the time to update the Employment Record section before submitting your application.

I have none of this type of experience.
I have some but less than 6 months of this type of experience.
I have at least 6 months but less than 12 months of this type of experience.
I have at least 12 months but less than 24 months of this type of experience.
I have more than 24 months of this type of experience.
 

CERTIFICATION: I hereby certify that I am the author of this Minimum Qualification Supplemental Questionnaire (MQSQ) and that all information is true and based on my experience. I understand that false or incorrect statements may result in my disqualification from the selection process for this position and/or dismissal from employment with the City and County of San Francisco. I also understand and agree that any information provided is subject to verification.