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#CBT-2616-901116
Supplemental Questionnaire

Last Name
First Name
 

Supplemental Questions

The purpose of this Supplemental Questionnaire is to obtain specific information regarding education, training and experience as they relate to the knowledge, skills, and abilities linked to the duties of this position.  This information will be used to assist in evaluating whether you possess the skill and experience, to determine your rank on the eligible list, and will be made available to departmental personnel and management staff to assist in their hiring decisions.  The information you provide on this questionnaire should be consistent with the application and is subject to verification.

CERTIFICATION

I hereby certify that I am the sole author of this supplemental application and that all information is true and is based on my background and experience, and is consistent with the information in my employment application.  I understand that any false or incorrect statement may result in my disqualification or dismissal from employment with the General Services Agency and City and County of San Francisco. I also understand and agree that any information provided is subject to verification.

Yes No
 

MQ1. Do you have a High School Diploma, or its equivalent (GED)?

Yes No
 

If you answered 'yes', please state the employer/s where you gained the experience and the dates of employment.

 

MQ3. Do you possess a current (unexpired) and valid Basic Food Safety Certification?

Yes No
 

MQ4. Do you have the physical ability to lift objects weighing up to fifty (50) pounds?

Yes No
 

1. How many years of verifiable experience do you have working in any type of kitchen in which you prepared food and maintained food safety and sanitation standards?

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

2. How many years of your kitchen experience involved working in an institutional kitchen, for example, in a school, hospital or other medical care facility, or a jail.

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

3. How many years of verifiable work experience do you have leading or supervising others performing any type of work?

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

4. How many years of verifiable work experience do you have leading or supervising others performing food service tasks?

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

5. How many years of verifiable work experience do you have ordering food and supplies, and maintaining inventory in a food service facility?

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

6. How many years of verifiable experience do you have working with office equipment, including computers, phone, etc.?

I do not have any experience in this area
I have some, but less than 1 year of experience
I have 1 year (minimum) to 1 year 11 months of experience
I have 2 year (minimum) to 2 year 11 months of experience
I have 3 year (minimum) to 3 year 11 months of experience
I have 4 year (minimum) to 4 year 11 months of experience
I have 5 or more years of experience
 

Please provide the name(s) and location(s) of the employer(s) where you gained this experience, if applicable.  If this question does not apply to you, type N/A in the box below.

 

7. If you have taken any courses in food preparation, food industry purchasing and inventory control, or restaurant management at a college or vocational school (such as a culinary school), please indicate the number of courses you have taken. 

Please only include full-length courses (quarter/semester, etc.), and exclude workshops and/or seminars.

Note that you may be required to provide transcripts or other proof of any stated education.

I have not taken any such courses
I have taken one course
I have taken two courses
I have taken three courses
I have taken four courses
I have taken five or more courses
 

If you indicated that you have taken courses in food preparation, food industry purchasing and inventory control, or restaurant management at a college or vocational school, list the course(s) and the name(s) of the school(s) where you took the courses in the box below.  If you have not taken such courses, type N/A. 

 

8. If you have any food service related certifications beyond a basic food safety certification (basic food safety certifications include the ServSafe Food Handler Certificate, California Food Handler Card, or equivalent), indicate the number of certifications you have.  Remember, these are certifications that are more advanced than the basic food safety certification, and may include the ServSafe Food Protection Manager Certification, Foodservice Management Professional Certification, Certified Food Service Professional, Certified Food Service Manager, or equivalent.

Note that you may be required to provide a copy of your certifications.

I have only the basic food safety certification, and do not have any advanced food service related certifications
I have one advanced certification
I have two advanced certifications
I have three or more advanced certifications
 

If you indicated that you have advanced food service related certifications, list them in the box below.  If you do not have any advanced certifications, type N/A. 

 

9. How much of this ability do you have?

Ability to meet work schedules and timelines while working under pressure of deadlines and interruptions.

I have none or a very limited amount of this knowledge or ability.
I have some of this knowledge or ability, but have not used it in a job setting.
I have this knowledge or ability and have used it to perform tasks under close supervision.
I have this knowledge or ability and have used it to perform tasks independently.
I have a substantial amount of this knowledge or ability and have used it to perform tasks independently and in a lead role or to train or provide consultation to others.
 

Please provide the name(s) and location(s) of the employer(s) where you used this knowledge or ability on the job.  If this question does not apply to you, type N/A in the box below.

 

10. How much of this ability do you have?

Ability to keep records as required.

I have none or a very limited amount of this knowledge or ability.
I have some of this knowledge or ability, but have not used it in a job setting.
I have this knowledge or ability and have used it to perform tasks under close supervision.
I have this knowledge or ability and have used it to perform tasks independently.
I have a substantial amount of this knowledge or ability and have used it to perform tasks independently and in a lead role or to train or provide consultation to others.
 

Please provide the name(s) and location(s) of the employer(s) where you used this knowledge or ability on the job.  If this question does not apply to you, type N/A in the box below.

 

11. How much of this ability do you have?

Ability to accurately add, subtract, multiply, and divide.

I have none or a very limited amount of this knowledge or ability.
I have some of this knowledge or ability, but have not used it in a job setting.
I have this knowledge or ability and have used it to perform tasks under close supervision.
I have this knowledge or ability and have used it to perform tasks independently.
I have a substantial amount of this knowledge or ability and have used it to perform tasks independently and in a lead role or to train or provide consultation to others.
 

Please provide the name(s) and location(s) of the employer(s) where you used this knowledge or ability on the job.  If this question does not apply to you, type N/A in the box below.

 

12. How much of this ability do you have?

Ability to work cooperatively with others.

I have none or a very limited amount of this knowledge or ability.
I have some of this knowledge or ability, but have not used it in a job setting.
I have this knowledge or ability and have used it to perform tasks under close supervision.
I have this knowledge or ability and have used it to perform tasks independently.
I have a substantial amount of this knowledge or ability and have used it to perform tasks independently and in a lead role or to train or provide consultation to others.
 

Please provide the name(s) and location(s) of the employer(s) where you used this knowledge or ability on the job.  If this question does not apply to you, type N/A in the box below.