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Supplemental Questionnaire

Last Name
First Name
 

CITY AND COUNTY OF SAN FRANCISCO

2470 DIAGNOSTIC IMAGING TECHNOLOGIST IV

SUPPLEMENTAL QUESTIONNAIRE

The purpose of this Supplemental Questionnaire is to obtain information regarding your education, experience and/or training in relation to this classification. This Supplemental Questionnaire must be completed and submitted online with the application. Responses cannot be changed or edited after submission. Failure to provide complete responses to this Supplemental Questionnaire may result in rejection of the application.

This Supplemental Questionnaire consists of two sections. The first section will be used as a tool to screen applications for minimum qualification requirements. The second will be used to measure your knowledge, skills and/or abilities in job-related areas.

By selecting "yes" below, you confirm that you understand that your qualifying education, experience and/or training MUST be included in the body of your application and in this Supplemental Questionnaire.

Yes No

 

INSTRUCTIONS: The purpose of the Minimum Qualifications section of the Supplemental Questionnaire is to assess whether the applicant meets the minimum qualifications for the classification. The minimum qualifications have been identified as critical for satisfactory performance in this classification. The information provided must be consistent with the information on your application and is subject to verification. The responses in this section of the Supplemental Questionnaire are mandatory for participation in this recruitment process.

Select the options that most closely describe the certifications that you possess. Please note, if the education/certifications listed on your application do not support the selections that you make on these questions, your application will be rejected. Be sure to include all relevant certifications and education on your application. A resume will not substitute for a completed application. If you write “see resume” on the application or Supplemental Questionnaire, your application will be rejected.


 

Minimum Qualification #1

I possess certification in, and current registration with, the American Registry of Diagnostic Medical Sonographers (ARDMS).
I do not presently have certification in, and current registration with, the American Registry of Diagnostic Medical Sonographers (ARDMS).
 

Minimum Qualification #2

I possess current certification in Cardio-Pulmonary Resuscitation(CPR)
I do not possess current certification in Cardio-Pulmonary Resuscitation(CPR)
 

If you answered that you have valid board certification with the ARDMS, please provide your certification number, your name as it appears on your certification, and the expiration date of your certification.  If you do not possess valid board certification as identified above, type N/A.

 

I understand that I must provide a copy of my certifications demonstrating that I possess the above stated certifications, if requested.


 

 


INSTRUCTIONS: The purpose of this portion of the Supplemental Questionnaire is to determine your knowledge, skills and abilities in job-related areas that have been identified as critical for satisfactory performance in this classification. The information provided here must be consistent with the information on your application and is subject to verification.  Please note, if the experience listed on your application does not support the selections that you make on these questions, your application may be rejected. Be sure to include all relevant experience in the work history sections of the application. A resume will not substitute for a completed application.

For each of the following statements select the corresponding amount of fulltime firsthand experience you have performing the stated task(s). If you performed the stated task(s) as a part-time employee, please note that 1,000 hours of qualifying experience is equivalent to 6 months of fulltime experience. Additionally, experience gained in a classroom and/or as a trainee on-the-job does not constitute firsthand experience. Please also provide the information requested in the text box following each statement.


1.

How many months of experience do you have performing diagnostic imaging procedures in the advanced modality of Diagnostic Medical Sonography. Including selecting and operating a variety of diagnostic ultrasound equipment for obstetrical, gynecological, and abdominal evaluations?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #1 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.

2.

How many months of experience do you have assessing general patient condition, including stability, pain and safety, and as necessary taking action consistent with appropriate standards?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #2 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.

3.

How many months of experience do you have documenting procedures and events in patient’s medical records and departmental logs, in accordance with regulatory, hospital and departmental standards? This also includes identifying images and documents with the patient.

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime experience as described
 

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 many months of experience do you have transporting patients using gurneys, wheelchairs and beds including transferring patients to and from the exam table?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

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.

How many months of experience do you have scheduling patients and procedures, including transferring paper orders into an electronic order entry system, processing paperwork and assisting patients and other customers?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

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.

6.

How many months of experience do you have setting up sterile and non-sterile trays, and providing instruments, medical devices and supplies as requested?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #6 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.

7.

How many months of experience do you have training medical and technical personnel, such as radiology residents and intern sonographers, in the science and practice of diagnostic sonography?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #7 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.

8.

How many months of experience do you have participating in quality control and assurance procedures, including quality improvement projects?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #8 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.

9.

How many months of experience do you have cleaning imaging equipment and calibrating as necessary; this also includes cleaning supplies and procedure rooms and acting as liaison with field service engineer to effect necessary repairs?

12 months or more of fulltime firsthand experience as described
6-11 months of fulltime firsthand experience as described
1-5 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

In accordance with your response to #9 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.

10.

Do you have experience working in a trauma center?

Yes No
 

If your response to #10 is YES, that you have experience working in a trauma center, what trauma level was the hospital that you worked in? (if you worked in multiple trauma centers, please select the highest level of the hospitals that you worked in).

Level 1
Level 2
Level 3
I do not have experience working in a trauma center
11.

Have you been involved in a process improvement strategy to streamline an organizational process? (such as implementing Lean Management for a hospital).

Yes No
 

In accordance with your response to #11 above, please describe the process that was utilized, your role in the project, 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, his or her contact information, and . If you do not have experience in these areas, please type N/A.

12.

Do you have experience performing 3D imaging?

Yes No
 

If you indicated yes on #12 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.

 

CERTIFICATION: I hereby certify that I am the author of this application and that all information is true and is based on my background, skills and experiences. I understand that any false or incorrect statement may result in my disqualification or dismissal from employment with the City and County of San Francisco. I understand and agree that any information provided is subject to verification.