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Human Capital Management
#170120-X31B-03


Supplemental Questionnaire

Last Name First Name
 

 

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire.  The questions below will be used for scoring purposes in lieu of a written exam.


1.

What experience do you have preparing and arranging comprehensive evaluation reports?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

2.

What experience do you have planning, developing and organizing all phases of your own work?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

3.

What experience do you have in counseling or conflict resolution?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

4.

What is your experience providing customer service to the public?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

5.

What experience do you have consulting with community service providers, clinicians, school personnel, and others on psychological issues?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

6.

What experience do you have interviewing clients and contacts to gather information concerning psychological issues?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

7.

Please check all types of tests you have experience administering.

Intelligence tests
Career or vocational tests
Developmental or behavioral assessments
Psychological tests
I have experience with other types of tests not listed.
I have no experience administering tests.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

8.

What is your experience developing treatment plans based on assessment results and interviews?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

9.

What experience do you have compiling statistical data and preparing cases and other types of reports?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

10.

Please check all participation you have had in meetings, conferences, training classes or seminars on psychological related issues.

I have attended meetings, conferences, training classes, or seminars on psychological related issues.
I have made poster presentations at meetings, conferences, training classes, or seminars on psychological related issues.
I have made audience presentations at meetings, conferences, training classes, or seminars on psychological related issues.
I have organized, developed, or coordinated conferences, training classes or seminars on psychological related issues.
I have not participated in any meetings, conferences, training classes or seminars on psychological related issues.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

11.

Please check all types of psyco-educational programs with which you have facilitated.

Parenting workshops
Children’s groups
Community outreach programs
Career or vocational programs
Substance abuse programs
Support groups
Treatment groups
I have facilitated other types of psycho-educational programs not listed.
I have no experience participating in psycho-educational programs.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

12.

What experience do you have maintaining confidential files or information?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

13.

What experience do you have researching and reviewing professional material to stay current on programs and resources for psychological issues?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

14.

What experience do you have establishing and maintaining partnerships with various agencies, public facilities, or organizations?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

15.

What experience do you have working with clients from a variety of cultures?

I have worked with clients from a variety of cultures as a regular part of my job.
I have occasionally worked with clients from a variety of cultures.
I am familiar with or have received some training on working with clients from a variety of cultures.
I have no experience working with clients from a variety of cultures.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

16.

Please check all of the following counseling services you have provided.

Family, marriage, adolescent, infant, or early childhood
Educational, learning, or intellectual disabilities
Adult or youth corrections
Substance abuse
Physical or mental disabilities
I have no experience with any of the listed counseling services.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

17.

Please check all of the following professional or psychological organizations to which you belong.

American Psychological Association
American Counseling Association
Behavior Analyst Certification Board (BACB)
National Rehabilitation Association
I belong to a professional or psychological organization not listed.
I do not belong to any professional or psychological organizations.
18.

What experience do you have working with people with mental health issues?

I have worked with people with mental health issues as a regular part of my job.
I have occasionally worked with people with mental health issues.
I am familiar with or have received some training on working with people with mental health issues.
I have no experience working with people with mental health issues.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

19.

What experience do you have preparing court ordered reports for discovery and giving depositions or testimony for court or board proceedings?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the university and location or employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.


 

Please make sure that you attach all requested documents to your application, if requested.  Resumes should be attached to the "Resume" tab and any other requested documents to the "Other" tab.