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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.


1a.

Select the statement that best describes your highest level of education.

No formal college/university education
Possession of a high school diploma or equivalent
Currently enrolled in an accredited undergraduate, graduate or certification program
1b.

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.

2.

Do you possess three (3) months (equivalent to 500 hours) or more of verifiable experience in a health setting (including work as a volunteer, intern or trainee)?

Yes No
 

By checking this box, I certify that my responses indicated above 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.