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#PBT-2540-094131
Supplemental Questionnaire

Last Name
First Name

 

2540 Audiologist
Supplemental Questionnaire

All applicants are required to complete the supplemental questionnaire as part of the online application process. The purpose of the supplemental questionnaire is to determine whether applicants possess the minimum qualifications for the 2540 Audiologist 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.


1

I have a license from the California Speech Language Pathology & Audiology Board as a Registered Audiologist:

Yes No
 

CERTIFICATION: By checking this box, I hereby certify that I am the author of the information supplied in this supplemental questionnaire.  I understand that any false or incorrect statements may result in my disqualification or dismissal from employment with the San Francisco Department of Public Health and City and County of San Francisco.  I also understand and agree that the information provided is subject to verification.