Official SealSan Joaquin County Human Resources Division


#0724-RS1082-01
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you possess two years as a Shelter Supervisor I in San Joaquin County?

Note:  For individuals employed in the San Joaquin County Class of Group Counselor II-DCH at the time of adoption of this class specification (October 11, 2000), shall meet the above experience requirement.

Yes No
2.

PATTERN II

This pattern requires graduation from an accredited four-year college or university and five (5) years of experience performing children's social services work in a shelter, group home or similar setting; or social casework experience for children and families, including two (2) years of experience in a supervisory position.

Indicate the name of your school and the type of degree completed.  Indicate your employment experience that meets this pattern requirement, including employer name, job title, dates of employment, hours worked per week, monthly salary, and a detailed description of your job duties.

3.

Do you possess a valid California driver's license?

Yes No
4.

If you answered "Yes" above, please provide your California driver's license number AND expiration date.