All applicants are required to complete the Supplemental Questionnaire as part of the online application process. Responses cannot be changed or edited after submission. Insufficient or non-responsive answers to the Supplemental Questionnaire may result in ineligibility, disqualification, or lower scores.
Responses to items on the Supplemental Questionnaire must be supported by the information provided on the application in order to receive appropriate credit. Please provide a response to each question below to the best of your ability. Please provide all information requested even if the information may appear redundant. Do not write, "See application" or “See resume.”
All experience and education referenced in this questionnaire MUST also appear in the work history and/or education sections of your application. The information provided must be consistent with the information on your application and is subject to verification.
NOTE: Falsifying one's education, training, or work experience or attempted deception on the application or Supplemental Questionnaire may result in disqualification for this and future job opportunities with the City and County of San Francisco.
It is suggested that you:
Allow ample time to submit your application and Supplemental Questionnaire responses before the filing deadline
Ensure that your responses are sufficiently detailed to assist in evaluating your knowledge, skills, and abilities
Make note of any error messages and contact the analyst before the filing deadline, if you experience technical difficulties
INSTRUCTIONS: The purpose of the Minimum Qualification Supplemental Questionnaire is to assess whether the applicant meets the minimum qualifications for the classification. The minimum qualifications have been identified as critical for satisfactory performance in this classification. The information provided must be consistent with the information on your application and is subject to verification. The responses on the Supplemental Questionnaire are mandatory for participation in this recruitment process.
1.
Indicate the amount of verifiable professional work experience you have working with a culturally diverse population performing a combination of at least two (2) of the following duties:
Serving as a liaison between targeted communities and healthcare agencies
Providing culturally appropriate health education/information and outreach to targeted populations
Providing referral and follow up services or otherwise coordinating care
Providing informal counseling, social support and advocacy to targeted populations
Escorting and transporting clients
Providing courier/dispatcher functions
Performing pre-clinical examinations of vital statistics, such as measuring a patient’s weight, height, temperature and blood pressure
I possess none of this experience.
I possess some, but less than 6 months of this experience.
I possess 6 to 11 months of this experience.
I possess 1 year to 1 year and 5 months of this experience.
I possess 1 year and 6 months to 1 year and 11 months of this experience.
I possess 2 years or more of this experience.
2.
Which year(s) you gained the experience above? Please check all that apply.
N/A - I do not possess the experience in the question above.
2013 and/or prior
2014
2015
2016
2017
2018
2019
3.
Indicate the experience(s) you possess from question 1. Please check all that apply.
N/A - I do not possess any of the experience indicated.
Serving as a liaison between targeted communities and healthcare agencies
Providing culturally appropriate health education/information and outreach to targeted populations
Providing referral and follow up services or otherwise coordinating care
Providing informal counseling, social support and advocacy to targeted populations
Escorting and transporting clients
Providing courier/dispatcher functions
Performing pre-clinical examinations of vital statistics, such as measuring a patient's weight, height, temperature and blood pressure
4.
Do you possess a Community Health Worker Certificate from City College of San Francisco?
Yes
No
CERTIFICATION: I hereby certify that I am the author of this supplemental questionnaire and that all information is true and based on my education, training, skills, and experience. I understand that any false or incorrect statement 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 understand and agree that any information provided is subject to verification.
Department of Human Resources