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Human Resources Department
#17-344020-01


Supplemental Questionnaire

Last Name First Name
 

 

This Supplemental Questionnaire will be used to determine applicants’ qualifications for this position and whether they will continue in the recruitment process; therefore, applicants are encouraged to answer all questions thoroughly and completely.  In your response, please include employer name and dates of employment. Omitted information will not be considered or assumed.  Applicants who have no experience in a specific area are recommended to state "no experience in this area" instead of leaving the space blank.


1

Mark the one box that best describes your experience and education from an accredited college or university.  NOTE: Depending on how you qualify, candidates must submit a copy of their college diploma (verifying the degree, date earned and area of specialization) or official/unofficial transcripts (verifying the courses and units completed) by the final filing deadline date.

Two years of experience equivalent to the Social Worker II in Solano County.
Equivalent to graduation from a four-year accredited college or university with coursework that has preferably included thirty (30) semester units in social welfare, sociology, psychology, counseling, gerontology, vocational guidance or other related behavioral science. AND Three years of experience performing professional level social work with a public social services agency or private social services provider. (Preferably including substantial experience with abused/neglected children and/or adults)
Possession of a Master’s degree in Social Services (MSW) or a two year graduate level counseling degree emphasizing marriage, family and child counseling, gerontology, or clinical psychology. (Both the MSW and the two-year counseling degree must have included supervised fieldwork or an internship) This requirement may be met by a letter from an accredited college or university that states current enrollment in a Master’s degree program and confirms graduation with a Master’s degree in Social Services (MSW) will be conferred within three (3) months. AND Two years of experience performing social work with a public social services agency or private social services provider. (Preferably including substantial experience with abused/neglected children and/or adults). This requirement may be met by completion of a two (2) year social work internship through an accredited college or university.
None apply
2

Are you a Title IV-E Student?

Yes No
3

Mark the boxes that best describes your training and/or paid experience as a Social Worker in the following settings.  Choose all that apply.

Child Welfare Services - Primary Case Manager
Child Welfare Services - Supportive Services
Education
Foster Family Agency
Children's Residential Care Services
Substance Abuse Services
Mental Health Services
Juvenile Justice
Domestic Violence Services
Hospital or Medical Care
None
4

Which statement describes your experience working as part of a multi-disciplinary team in needs assessment and/or service plan development?

I have no experience in this area.
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
5

Mark the boxes that best describe your experience preparing professional documents.

I have no experience in this area.
I have experience writing court reports and legal documents.
I have experience writing case plans/service plans, including goals and objectives.
I have experience writing detailed case notes
I have experience writing evaluation documentation/discharge summaries
I have experience writing professional e-mail communication.
I have experience writing letters to clients.
6

Select the boxes that best describe populations of community members with whom you have directly interacted and interviewed effectively in a professional capacity.

Foster parents
Ethnic and/or cultural groups or populations different than myself
Children/Youth
Hostile or argumentative clients
Children in and out of home placement
Clients with mental illness or substance abuse
Clients with substantiated child abuse and neglect
None
7

Select the one box that best describes experience assessing safety and risk to children using the Structured Decision Making (SDM) tools.

I have no experience in this area.
I have unpaid internship/externship experience only.
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
8

Mark the one box that best describes your experience providing direct case management services for children.

I have no experience in this area.
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
9

Select the boxes that best describes your experience conducting home visits with clients for the following purposes.

I have no experience in this area.
Teaching and demonstrating parenting skills.
Completing Foster Family Agency Social Worker home visits.
Providing wraparound services in the home.
Conducting County home visits for Public Health, Mental Health, and/or Probation.
Completing Child Welfare Services home visits.
Conducting Child Welfare Services abuse and neglect investigations.
10

Select the boxes that describe your experience interviewing clients to assess and evaluate for appropriate services and to address service barriers.

I have no experience in this area.
I have created case plans with client input.
I have monitored case plans and completed progress updates.
I have addressed barriers to case plan objectives.
I have updated or modified case plans with client input.
I have reported to the Court on case plan progress.
11

Select the one box that best describes your experience working with foster parents or substitute care providers and providing services in support of a successful placement.

I have no experience in this area.
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
12

Select the one box that best describes your experience completing psychosocial assessments.

I have no experience in this area.
I have unpaid internship/externship experience only
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
13

Select the one box that best describes your experience interpreting and applying rules, regulations, policies, and procedures as well as explaining them to any or all of the following: staff, clients, the public, or other agencies.

I have no experience in this area.
I have unpaid internship/externship experience only
Less than six (6) months of full time paid (or equivalent) experience.
Six (6) months but less than 12 months of full time paid (or equivalent) experience.
One (1) year of full time paid (or equivalent) experience.
More than one (1) year of full time paid (or equivalent) experience.
14

Select the boxes that describe your experience interacting with Juvenile Court.

I have no experience in this area.
I have created legal documents for court.
I have worked with counsel representing clients in court
I have followed and carried out court orders.
I have testified in Juvenile Court.
15

Select the boxes that reflect the areas in which you have experience as a Social Worker.

Working with children within the educational system, juvenile justice, mental health or child welfare services agency.
Working with adults, including older and disabled adults.
16

Select the boxes that reflect the areas in which you have interest in working as a Social Worker.

Working with children
Working with adults
17

Some positions may require bilingual skills.  Applicants who indicate bilingual skills in their application may be required to demonstrate proficiency in speaking, reading and writing in the language indicated.

Are you proficient in speaking, reading and writing any of the following languages? (select all that apply)   

                 

Spanish
Tagalog
Vietnamese
None