Official SealDepartment of Human Resources


#TEX-9924-093021
Supplemental Questionnaire

Last Name
First Name

 

All applicants are required to complete the supplemental questionnaire as part of the online application process. The purpose of the supplemental application is to determine whether applicants possess the minimum qualifications and the desired qualifications for the 9924 Public Service Aide (Peer Specialist Trainee) position. This information should be consistent with your application (i.e. must be included in the Education and Training and Employment Record sections) and is subject to verification.


1a.

How much verifiable full-time equivalent experience do you have working or volunteering in a health care setting or agency that serves families? (Full-time is equivalent to 40 hours per week.)

As a reminder, all qualifying experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the work experience you are about to describe in the "Employment Record" section of your application, you will not receive credit for this experience. If you are copying an old application, please take the time to update your Employment Record before submitting your application.

I do not possess any experience working or volunteering in a health care setting or agency that serves families.
I possess less than 3 months (500 hours) of experience working or volunteering in a health care setting or agency that serves families.
I possess at least 3 months (minimum 500 hours) but less than 6 months (1,000 hours) of experience working or volunteering in a health care setting or agency that serves families.
I possess at least 6 months (minimum 1,000 hours) but less than 12 months (2,000 hours) of experience working or volunteering in a health care setting or agency that serves families.
I possess at least 12 months (minimum 2,000 hours) of experience working or volunteering in a health care setting or agency that serves families.
1b.

Please provide the name of the organization(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained your verifiable work and/or volunteer experience as indicated in Question #1a.

In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you selected that you do not have experience, please type N/A.

Do not type “See Resume.”

2.

Please describe your knowledge and/or experience working or volunteering in a major children serving systems such as Human Services Agency, Juvenile Justice Department, Community Behavioral Health and/or Special Education System.

3.

Please describe your experience in the following areas:

  • conducting outreach
  • providing education
  • case management
  • community organizing
  • peer support
  • advocacy
  • consumer advisory activities
 

CERTIFICATION: I hereby certify 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 of 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.