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Supplemental Questionnaire

Last Name
First Name



The purpose of the Supplemental Questionnaire is to determine whether you meet the Minimum Qualifications for the 0922 Manager I, Patient Communications Manager position.



Please select the highest level of education that you have completed.

High School Diploma or equivalent
Associate's degree
Bachelor's degree
Master's Degree
Doctoral Degree
None of the above

Please select your degree major:

Other related degree- please describe in next response

Please list the school(s) where you obtained your degree(s) as well as the type of degree earned (e.g. Doctor of Medicine degree from the University of California, Los Angeles).  If you do not possess any of the degrees identified above, type N/A.


Do you have three (3) years full-time (6000 equivalent hours) experience performing professional-level work in marketing, communications, internal communications, patient/client communications, business strategy, systems design or change management.

Yes No

In accordance with your responses to #B1 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.


I understand that checking this box will serve as my electronic signature.  I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience.  I understand and agree that any information provided is subject to verification.  I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.