The purpose of this Supplemental Questionnaire is to 1) assess each candidate's possession of the minimum qualifications; and 2) obtain information regarding your education, experience and/or training in relation to this classification.
This Supplemental Questionnaire consists of two sections. The first section will be used as a tool to screen applications for minimum qualification requirements. The second section will be used to measure your knowledge, skills and/or abilities in job-related areas.
This Supplemental Questionnaire must be completed and submitted online with the application. Responses cannot be changed or edited after submission. Failure to provide complete responses to the Supplemental Questionnaire may result in rejection of the application.
Responses to Supplemental Questionnaire items must be supported by the information provided in the body of your application (i.e. education and training/employment record section) in order to receive appropriate credit, and are subject to verification. Verification of education and experience may be collected at any time during or after the selection process.
INSTRUCTIONS: Please answer all applicable questions by choosing the best response that matches your education, experience, and/or by providing the information requested.
INSTRUCTIONS:
Select the options below that most closely describe the certification that you possess.
Please note, if the education/certifications listed on your application do not support the selections that you make on these questions, your application may be rejected. Be sure to include all relevant certifications and education on your application. A resume will not substitute for a completed application. If you write “see resume” on the application or Supplemental Questionnaire, your application may be rejected.
QUESTION 1:
I currently possess a valid certificate issued by the American Registry for Diagnostic Medical Sonography (ARDMS).
I do NOT currently possess a valid certificate issued by the American Registry for Diagnostic Medical Sonography (ARDMS).
Please indicate below which certificate(s) you possess that has/have been issued by the American Registry for Diagnostic Medical Sonography (ARDMS). If you do not possess a valid certificate issued by ARDMS, please type "N/A"
QUESTION 2:
I possess a valid Cardiopulmonary Resuscitation (CPR) certificate issued by the American Heart Association.
I DO NOT possess a valid Cardiopulmonary Resuscitation (CPR) certificate issued by the American Heart Association.
Please indicate below the type, issue date, and certificate number of the CPR certificate that you possess. If you do not possess a valid CPR certificate, please type "N/A" below.
QUESTION 3:
Please indicate below in which advanced modalities you possess certification. Please check all that apply.
Abdomen (AB) certificate issued by the American Registry for Diagnostic Medical Sonography.
Obstetrics & Gynecology (OG/BYN) certificate issued by the American Registry for Diagnostic Medical Sonography
Breast (BR) certificate issued by the American Registry for Diagnostic Medical Sonography
Other (please elaborate in text area in question below)
I do not currently possess certification in any of the above listed advanced modalities.
Please elaborate on which advanced modality you possess a valid certificate in that was not listed above:
QUESTION 4:
Please indicate below which certificate you possess. Please select all that apply.
I possess a valid certificate in Nuchal Translucency issued by the Perinatal Quality Foundation.
I possess a valid certificate in Vascular Sonography issued by the American Registry for Diagnostic Medical Sonography
I possess a valid certificate in Pediatric Sonography issued by the American Registry for Diagnostic Medical Sonography
Other
I do not currently possess certification in any of the above listed modalities.
Please elaborate on which modality you possess a valid certificate in that was not listed above:
How many months/years of verifiable full-time experience do you possess working as a Diagnostic Medical Sonographer?
I have less than 6 months of this experience.
I have at least 6 months (1,000 hours minimum) but less than 12 months (2,000 hours) of this experience.
I have at least 12 months (2,000 hours minimum) but less than 18 months (3,000 hours) of this experience.
I have at least 18 months (3,000 hours minimum) but less than 24 months (4,000 hours) of this experience.
I have at least 24 months (4,000 hours minimum) of this experience.
I do not have any of this experience.
2473 SUPPLEMENTAL QUESTIONNAIRE: PART II
INSTRUCTIONS:
For each of the following statements select the corresponding amount of fulltime firsthand experience you have performing the stated task(s). If you performed the stated task(s) as a part-time employee, please note that 1,000 hours of qualifying experience is equivalent to 6 months of fulltime experience. Additionally, experience gained in a classroom and/or as a trainee on-the-job does not constitute firsthand experience.
1.
Performing general sonographic imaging procedures on all age groups for outpatient, impatient and emergency patients.
24 months or more of fulltime firsthand experience as described
12-23 months of fulltime firsthand experience as described
1-11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
2.
Positioning patients and selecting technical factors based on knowledge of sonographic science, specific equipment and patient assessment, including processing films.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1-11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
3.
Performing sonographic imaging procedures in one of the following advanced modalities: Abdomen (AB), Obstetrics & Gynecology (OG/BYN)
24 months or more of fulltime firsthand experience as described
12 - 23 months or more of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
4.
Applying principles of sonography safety in compliance with federal, state, and departmental logs, in accordance with regulatory, hospital and departmental standards; This includes using appropriate filters, cones, protective clothing and devices to obtain high-quality images with radiation exposure levels as low as reasonably achievable to patients, others and self and wearing and exchanging radiation monitoring devices.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
5.
Assessing general patient condition, including stability, pain, safety and, as necessary, taking action consistent with standards; monitors medical equipment and promptly adjusts or reports problems; observes and documents patient physical and procedural restraints.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
6.
Documenting procedures and events in patient medical records and departmental logs, in accordance with regulatory, hospital and departmental standards.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
7.
Assisted physicians in preparing and/or administering contrast media.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
8.
Assisted in training and evaluation of imaging technologist students, interns and/or staff.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
9.
Participated in quality control and assurance procedures, including quality improvement projects.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
10.
Maintained patient medical records and data integrity using radiology IT systems.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
11.
Performed charge technologist duties.
24 months or more of fulltime firsthand experience as described
12 - 23 months of fulltime firsthand experience as described
1 - 11 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
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 that prior to an appointment I may be required to provide written verification of any of the information provided above and that I may be required by the hiring department to participate in performance test(s) during the probationary period. 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.