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Human Capital Management
#170927-H10A-04


Supplemental Questionnaire

Last Name First Name
 

 

OK Department of Human Services (DHS) requires that the following questions be answered before continuing with the application.


1

Do you have legal status to work in the United States?

Yes No
2

Have you had a protective order entered against you pursuant to the Oklahoma
Protection from Domestic Abuse Act or a similar statute of another state? 

If yes, provide the name of the court and court number in the text area:

If no, please enter No in the text area:            

3

DHS policy does not allow some family members to be employed within the same supervisory group or unit. Please list the names of all of your relatives now employed by DHS:

If no, please enter No in the text area:

4

Have you ever been terminated or resigned from employment in lieu of being terminated?  
If yes, explain circumstances:      

If no, please enter No in the text area:


 

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 participating in program analysis, including the analysis of problems and needed services?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
2.
What experience do you have advising program staff and other interested groups of the proper interpretation and application of agency rules and policies?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
3.
I have experience reviewing:
  (Check all that apply.)
program activities.
periodic staff reports.
administrative audits.
information to evaluate program effectiveness and quality of service.
I have no experience in any of the above mentioned areas.
 
Please list the employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
4.
What experience do you have observing work activities of local staff to report quality and quantity of work performed?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
5.
What experience do you have preparing written reports and recommendations regarding the general status and progress of each local program for which you are responsible?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
6.
I have work experience ensuring proper interpretation and uniform application of policies, procedures, rules and regulations in such program areas as:
  (Check all that apply.)
public health.
public health.
licensing services.
medical assistance.
income maintenance.
child welfare services.
rehabilitative services.
community health services.
developmental disability services
court-related and community services.
human resources/personnel programs or issues.
I have no experience in any of the above mentioned areas.
 
Please list the employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
7.
What experience do you have conducting on-site reviews of local records, files and other documents?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
8.
What experience do you have developing or providing training to various personnel?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
9.
What experience do you have communicating or coordinating various activities with different agencies or outside entities?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
10.
I have experience developing controls in various units to assure accountability for:
  (Check all that apply.)
program operation.
policy implementation.
the maintenance of efficiency.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
11.
What experience do you have managing an agency unit, section, division or program and directing or supervising staff in the completion of assigned functions and activities?
I have performed this function independently on a regular basis.
I have assisted with this function on a regular basis.
I have assisted with this function on an occasional basis.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.
12.
What experience do you have developing and recommending policies, rules or regulations?
I have performed this task independently on a regular basis.
I have performed this task on a regular basis 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 employer and job title where you gained your experience as indicated in the response above and the length of experience in years. If you indicated "no experience", then please type N/A below.