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#TPV-2930-074152
Supplemental Questionnaire

Last Name
First Name

 

2930 Behavioral Health Clinician(TPV-2930-074152)
Supplemental Questionnaire

The purpose of this Supplemental Questionnaire is to determine whether you meet the minimum qualifications and special conditions of this 2930 Behavioral Health Clinician position.

The information provided should be consistent with the information on your application and is subject to verification. Verification of experience, licensure, and possession of valid certifications/certificates may be collected at any time during or after the selection process so please choose the best answer for the questions below.


1

The 2930 Behavioral Health Clinician requires possession of one of the following licenses issues by the California Board of Behavioral Sciences (BBS). Not that the licnse must be current and valid at the time of the filing deadline of the announcment. If you do not possess the required licensure you will not be able to continue in the selection process for this classification.

Please indicate which of the following licenses issued by the California BBS you possess:

Licensed Clinical Social Worker (LCSW) license.
Associate Social Worker (ASW) license.
Marriage and Family Therapist (MFT) license.
Marriage and Family Therapist Intern (MFTI) license.
Professional Clinical Counselor (LPCC) license.
Professional Clinical Counselor Intern (PCCI) license.
I do not possess any of the above licenses.
2

Please provide the License/Registration Number and the expiration date. If you do not possess the required licensure please type N/A.

3

As a special condition for this 2930 Behavioral Health Clinician position, one (1) year of experience working in a jail mental health services environment is required.

Please indicate how many years of experience you have working in a jail mental health services environment:

I do not have any experience as described above.
1 month - 11 months.
1 year - 1 year, 11 months.
2 years - 2 years, 11 months.
3 years - 3 years, 11 months.
4 years - 4 years, 11 months.
More than 5 years of experience.
 

Please provide the following information for the experience you indicated above. Note: Information provided must be consistent with the information listed on your application.

  • Name of the organization(s) where the experience was obtained
  • Dates of experience (e.g. MM/YYYY - MM/YYYY)
  • Name and contact information of a supervisor/manager who can verify

If you do not have experience in this area, please type "N/A".

4

As a special condition for this 2930 Behavioral Health Clinician position, bilingual fluency in Spanish is required.

Please check whether or not you have Spanish bilingual fluency:

Yes No
 

CERTIFICATION: By checking this box, I certify that I am the author of this application and supplemental questionnaire and that all information is true based on my background, skills and experiences. I understand that any false, incomplete or incorrect statement, regardless of when it was discovered, may result in my disqualification or dismissal from my employment with the City and County of San Francisco. I understand and agree that any information provided is subject to verification.