Official SealSan Joaquin County Human Resources Division


#1021-RS3042-AC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a master's degree from an accredited school of social work?

Yes No
 

If you answered Yes, please provide the following information:

  • Name of college or university from which you graduated
  • Degree obtained
  • Major/Emphasis
2.

Do you possess a valid California license as a Clinical Social Worker?

Yes No
 

If you answered Yes, please provide your license number and expiration date. 

3.

Do you have one year of full-time, paid, post MSW social casework experience?

Yes No
 

If you answered YES, please describe your one year of full-time, paid, post MSW work experience and include the following information:

  • Name of employer
  • Dates of employment
  • Job title
  • Number of hours worked per week
  • Specific duties performed
4.

This position requires possession of a valid California driver's license.  Please provide your license number and expiration date.