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#PBT-1070-112828
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.

Please note that one year of full-time employment is equivalent to 2,000 hours (2,000 hours of qualifying work experience is based on a 40 hour work week). Any overtime hours that you work above 40 hours per week are not included in the calculation to determine full-time employment.


1a.

Based on your Education, indicate the selection that best matches your HIGHEST educational attainment (do NOT count units that are in progress).

High School Diploma/G.E.D.
Attended some college and possess 30-59 semester units/45-89 quarter units of coursework from an accredited college or university.
Attended some college and possess 60-89 semester units/90-134 quarter units of coursework from an accredited college or university.
Completion of an Associates Degree from an accredited college or university.
Attended some college and possess 90+ semester units/135+ quarter units of coursework from an accredited college or university.
Completion of a Baccalaureate Degree from an accredited college or university.
Completion of a Master's degree from an accredited college or university.
None of the above.
1b.

Based on your Education, indicate the subject matter below that best matches the major of your degree, or the majority of your coursework.

Computer Science
Other closely related field
Other unrelated field
Completion of the 1010 Information Systems Trainee Program.
None of the above
2.

How many years of experience in system administration, information systems development, maintenance and support, or information technology project management do you possess?

I have some but less than 5 years of this type of experience.
I have at least 5 years (minimum 10,000 hours) but less than 6 years (12,000 hours) of this type of experience.
I have at least 6 years (minimum 12,000 hours) but less than 7 years (14,000 hours) of this type of experience.
I have at least 7 years (minimum 14,000 hours) but less than 8 years (16,000 hours) of this type of experience.
I have at least 8 years (minimum 16,000 hours) but less than 9 years (18,000 hours) of this type of experience.
I have more than 9 years of this type of experience.
I have none of this type of experience.
3.

How many years of SUPERVISORY experience do you possess in system administration, information systems development, maintenance and support, or information technology project management?

I have some, but less than 1 year of this type of supervisory experience.
I have at least 1 year (2,000 hours minimum), but less than 2 years (4,000 hours) of this type of supervisory experience.
I have at least 2 years (4,000 hours minimum ), but less than 3 years (6,000 hours) of this type of supervisory experience.
I have at least 3 years (6,000 hours minimum) of this type of supervisory experience.
I do not have any of this type of supervisory experience.
4a.

How many years of verifiable and recent experience do you possess as a technical liaison to enterprise IT projects?

I have some but less than 3 years of this type of experience.
I have at least 3 years (minimum 6,000 hours) but less than 4 years (8,000 hours) of this type of experience.
I have at least 4 years (minimum 8,000 hours) but less than 5 years (10,000 hours) of this type of experience.
I have at least 5 years (minimum 10,000 hours) but less than 6 years (12,000 hours) of this type of experience.
I have at least 6 years (minimum 12,000 hours) but less than 7 years (14,000 hours) of this type of experience.
I have more than 7 years of this type of experience.
I have none of this type of experience.
4b.

Please provide the following information for the experience you provided above:

  • Name of the employer/setting where this experience was obtained
  • Dates of experience (eg. MM/YYYY - MM/YYYY)
  • Contact information of supervisor or other person who can verify you performed specific activities.

Note: Do not copy and paste resume or do not type "See Resume" or "See Attachment." If you do not have this type of experience, type "N/A."

5a.

How many years of experience do you possess managing information technology projects including business process analysis and consolidation, overall project control and facilitating among multiple projects and multiple business sections, through the project life-cycle of project initiation, planning, execution, control and closing? 

I have some but less than 3 years of this type of experience.
I have at least 3 years (minimum 6,000 hours), but less than 4 years (8,000 hours) of this type of experience.
I have at least 4 years (minimum 8,000 hours), but less than 5 years (10,000 hours) of this type of experience.
I have at least 5 years (minimum 10,000 hours), but less than 6 years (12,000 hours) of this type of experience.
I have at least 6 years (minimum 12,000 hours), but less than 7 years (14,000 hours) of this type of experience.
I have more than 7 years of this type of experience.
I do not have any of this type of experience.
5b.

Was this experience, if any, that you possess from within the last five (5) years

(This is the experience managing information technology projects including business process analysis and consolidation, overall project control and facilitating among multiple projects and multiple business sections, through the project life-cycle of project initiation, planning, execution, control and closing.)

Yes No
5c.

Please provide the following information for the experience you provided above:

  • Name of the employer/setting where this experience was obtained
  • Dates of experience (eg. MM/YYYY - MM/YYYY)
  • Contact information of supervisor or other person who can verify you performed specific activities.

Note: Do not copy and paste resume or do not type "See Resume" or "See Attachment." If you do not have this type of experience, type "N/A."

6.

Please indicate which of the below certifications, if any, that you currently possess. Please indicate all that apply.

PMP (Project Management Professional)
Lean
Scrum
ITIL (Information Technology Infrastructure Library)
None of the above.
7a.

How many years of experience do you possess implementing software projects in a health care setting?

I have less than 3 years of this type of experience.
I have at least 3 years (6,000 hours minimum) but less than 4 years (8,000 hours) of this type of experience.
I have at least 4 years (8,000 hours minimum) but less than 5 years (10,000 hours) of this type of experience.
I have at least 5 years (10,000 hours minimum) but less than 6 years (12,000 hours) of this type of experience.
I have at least 6 years (12,000 hours minimum) but less than 7 years (14,000 hours) of this type of experience.
I have at least 7 years (14,000 hours minimum) of this type of experience.
I have none of this type of experience.
7b.

Please provide the following information for the experience you provided above:

  • Name of the employer/setting where this experience was obtained
  • Dates of experience (eg. MM/YYYY - MM/YYYY)
  • Contact information of supervisor or other person who can verify you performed specific activities.

Note: Do not copy and paste resume or do not type "See Resume" or "See Attachment." If you do not have this type of experience, type "N/A."

8a.

How many years of experience of verifiable full-time experience do you possess as an IT infrastructure technical project manager, which includes work related to setting up sites with networking devices, servers and end points functions in a health care setting?

I have less than 3 years of this type of experience.
I have at least 3 years (6,000 hours minimum) but less than 4 years (8,000 hours) of this type of experience.
I have at least 4 years (8,000 hours minimum) but less than 5 years (10,000 hours) of this type of experience.
I have at least 5 years (10,000 hours minimum) but less than 6 years (12,000 hours) of this type of experience.
I have at least 6 years (12,000 hours minimum) but less than 7 years (14,000) of this type of experience.
I have at least 7 years (14,000 hours) of this type of experience.
I have none of this type of experience.
8b.

Please provide the following information for the experience you provided above:

  • Name of the employer/setting where this experience was obtained
  • Dates of experience (eg. MM/YYYY - MM/YYYY)
  • Contact information of supervisor or other person who can verify you performed specific activities.

Note: Do not copy and paste resume or do not type "See Resume" or "See Attachment." If you do not have this type of experience, type "N/A."

9a.

How many years of experience do you possess managing EPIC projects?

I have some but less than 1 year (2,000) of this type of experience.
I have at least 1 year (minimum 2,000 hours), but less than 2 years (4,000 hours) of this type of experience.
I have at least 2 years (minimum 4,000 hours), but less than 3 years (6,000 hours) of this type of experience.
I have at least 3 years (minimum 6,000 hours), but less than 4 years (8,000 hours) of this type of experience.
I have at least 4 years (minimum 8,000 hours), but less than 5 years (10,000 hours) of this type of experience.
I have at least 5 years (minimum 10,000 hours) of this type of experience.
I do not have any of this type of experience.
9b.

Please provide the following information for the experience you provided above:

  • Name of the employer/setting where this experience was obtained
  • Dates of experience (eg. MM/YYYY - MM/YYYY)
  • Contact information of supervisor or other person who can verify you performed specific activities.

Note: Do not copy and paste resume or do not type "See Resume" or "See Attachment." If you do not have this type of experience, type "N/A."

 

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. 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.