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#PBT-0931-067255
Supplemental Questionnaire

Last Name
First Name

 

0931 MANAGER III (PBT-0931-067255)

DIRECTOR OF SOCIAL SERVICES

SUPPLEMENTAL QUESTIONNAIRE

 

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY

 

The purpose of the Supplemental Questionnaire is to assist with determining if you possess the Minimum and Desired Qualifications for the 0931 Manager III – Director of Social Services position. Responses should be consistent with the information on your employment application and are subject to verification.

It is suggested that you allow ample time to submit your application and Supplemental Questionnaire responses before the filing deadline. If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline.


1.

Please select the highest level of education that you have completed.

High School Diploma or equivalent
Associate's degree
Bachelor's degree
Master's degree
Doctoral degree
None of the above
 

Please list the school(s) where you obtained your degree(s) as well as the discipline/field of study and type of degree earned (e.g. Bachelor's degree in Psychology from San Jose State University). If you do not possess any of the degrees identified above, type N/A.

2.

Do you have a valid license issued by the California Board of Behavioral Sciences as a Licensed Clinical Social Worker (LCSW)?

Yes No
 

If you answered that you possess a valid license in #2 above, please provide your license number, your name as it appears on your license, and the expiration date of your license. If you do not possess a license as identified above, type N/A.

3.

How much professional experience do you have as a Social Worker?

I have less than 12 months of experience
I have at least 12 months, but not more than 23 months of experience
I have at least 24 months, but not more than 35 months of experience
I have at least 36 months, but not more than 47 months of experience
I have at least 48 months, but not more than 59 months of experience
I have at least 60 months, but not more than 71 months of experience
I have 72 months or more of experience
None of the above
 

In accordance with your response to #3 above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the verifiable full-time equivalent work experience.

Additionally, 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 do not have experience in these areas, please type N/A.

4.

How much of your professional Social Worker experience included supervising other Social Workers in an acute care hospital*?

 

*An acute care hospital provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.

I have less than 12 months of experience
I have at least 12 months, but not more than 23 months of experience
I have at least 24 months, but not more than 35 months of experience
I have at least 36 months, but not more than 47 months of experience
I have at least 48 months, but not more than 59 months of experience
I have at least 60 months, but not more than 71 months of experience
I have 72 months or more of experience
None of the above
 

In accordance with your response to #4 above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the verifiable full-time equivalent work experience.

Additionally, 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 do not have experience in these areas, please type N/A.

5.

Please identify additional abilities and areas of experience as a Social Worker. Select all that apply:

Experience providing compassionate and respectful attention for each person, during each encounter
Experience inspiring teams to work together for a common goal
Excellent verbal, written, and interpersonal communication abilities
Experience with continuous improvement using the framework and tools of Lean/Toyota Production System
Strong computer abilities, including Word, Excel, PowerPoint, etc.
 

In accordance with your response to #5 above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the verifiable full-time equivalent work experience.

Additionally, 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 do not have experience in these areas, please type N/A.

 

I understand that checking this box will serve as my electronic signature. I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience. I understand and agree that any information provided is subject to verification. I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.