Department of Human Resources

The purpose of this Supplemental Questionnaire is to determine your skill and experience as they relate to the knowledge, skills, and abilities linked to the duties of this position.  The information will be used to assist in evaluating whether you possess the skill and experience, and will be made available to departmental personnel and management staff to assist in their hiring decisions.  The information you provide on this questionnaire should be consistent with the application and is subject to verification.

Do you possess a Baccalaureate Degree from an accredited college or university?

If you answered 'Yes' please provide the date, location, and field in which the degree was obtained.  If you answered 'No' please indicate 'N/A.'

Please provide the name, address and dates of attendance of the institution where you gained baccalaureate degree. (Enter multiple institutions, if applicable.)

Do you possess certification as a Certified Safety Professional (CSP)?

Do you have a Masters Degree?

If you answered 'Yes' please provide the date, location, and field in which the degree was obtained.  If you answered 'No' please indicate 'N/A.'

Please provide the name, address and dates of attendance of the institution where you gained your Masters (or higher) degree. (Enter multiple institutions, if applicable.)

Please indicate the amount of professional occupational safety experience experience you possess.  This includes implementing occupational safety programs, conducting worksite inspections and conducting safety training. (Note: Weapons, Ordinance, and Systems Safety experience is not qualifying).

CERTIFICATION:  By completing this form, I certify that my responses are true and complete to the best of my knowledge. I understand and agree that any information provided is subject to verification. I also understand that falsification of this record may result in my disqualification or dismissal from employment with the City and County of San Francisco.