Official SealDepartment of Human Resources


#PEX-9910-074445
Supplemental Questionnaire

Last Name
First Name

 

Supplemental Questionnaire

All applicants are required to complete the supplemental questionnaire as part of the online application process. The purpose of the supplemental questionnaire is to determine whether applicants possess the minimum qualifications and desirable qualifications for the position. This information should be consistent with your application (i.e., must be included in the Education and Training and Employment Record sections) and is subject to verification.


1.

Please provide the name of the school you attended or currently attend and the field of study you completed or will complete your degree in. If this does not apply to you please type "N/A" in the box below.

2a.

Have you completed a Medical Interpreter educational program of at least 10 months (equivalent to 350 hours) of classroom and internship work that is administered by an accredited educational institution?

Yes No
2b.

Please provide the name of the Medical Interpreter education program you attended for at least 10 months in a classroom setting and/or internship work.

3.

Are you fluent in English and any of the languages listed below?

I am not fluent in any other language
Cantonese
Mandarin
Spanish
Russian
 

I understand that checking this box will serve as my electronic signature.  I certify that I am the author of this form and all information presented is true and based upon my work education and/or work experience.  I understand that prior to an appointment, I may be required to provide written verification of any of the information provided above and, during the probationary period, I may be required by the hiring department to participate in (a) performance test(s).  I further understand that any false, incomplete, or incorrect statement may result in disqualification, dismissal, or termination of employment from the City and County of San Francisco.