Official SealHuman Resource Services Department


#19-6214-01
Supplemental Questionnaire

Last Name
First Name
1

IMPORTANT:  Applicants for this position are required to submit responses to the following supplemental questions. 

By selecting yes below, you certify your understanding that all applicants must meet minimum qualifications in order to move forward in the process.  Do you understand the above statement?
Yes No
2

Are you 21 years of age or older?
Yes No
3

Did you graduate from high school, attain a satisfactory score on a G.E.D. test, or pass a California High School proficiency examination?
Yes No
4

Are you a citizen of the United States, or a permanent resident alien who is eligible for, and has applied for, citizenship?
Yes No
5

Do you currently work, or have you previously worked, as a Juvenile Institutional Officer Intermittent for at least six months in the Alameda County classified service?
Yes No
6

Do you possess the equivalent of one year of full-time experience involving the organization, direction, or supervision of youth groups in correctional counseling, or in a recreational or correctional setting?

If you answer "yes" to this question, please ensure that your experience is clearly outlined in your application. Simply checking "yes" to this question, and/or only including this information on your supplemental questionnaire, will NOT substitute for a properly/completely filled out application, and will result in disqualification.
Yes No
7

Please list successfully completed college coursework that may be expected to provide the knowledge and skills required for this position. List each course individually, and include the school, course title, and number of units. In order to meet the educational minimum qualification, these courses must be equal to or greater than 30 semester, or 45 quarter, units. Coursework in the field of social sciences is highly desirable.
8

Do you possess a valid California Driver's License?  If yes, please ensure this information is indicated on your application.
Yes No
9

Juvenile Institutional Officer Associates may be assigned to work day, evening and rotating shifts, including weekends and holidays. I understand that I may be assigned, and must be available to work, any shift.
Yes No
10

I understand that a thorough background investigation will be conducted on all prospective Juvenile Institutional Officers to ensure they are suitable for work within a 24-hour Juvenile Probation facility.
Yes No
11

Are you on probation/parole?
Yes No
12

Have you ever been the subject of an emergency protective order/restraining order/stay-away order?
Yes No
 

If yes, please provide the date the emergency protective order/restraining order/stay-away order was issued (mm/dd/yyyy).
13

Have you ever fraudulently received welfare, unemployment compensation, workers’ compensation, or other state or federal assistance?
Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).
14

Have you ever sold, released, or given away any confidential information?
Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).
15

Are you a member or associate of a criminal enterprise, street gang, or any other group that advocates violence against individuals because of their race, religion, political affiliation, ethnic origin, nationality, gender, sexual preference or disability?
Yes No
 

If yes, please provide the name of the group that you are affiliated with.
16

Have you ever filed a false insurance or workers’ compensation claim?
Yes No
 

If you answered yes, please give the date (mm/dd/yyyy).
17

Have you ever committed a crime(s) for which you have NOT been arrested for?
Yes No
 

If you answered yes, please provide the crime(s) and date(s) (mm/dd/yyyy).

 

At any time in your life, have you EVER committed any of the following acts? (NOTE: You may NOT withhold any information regarding your involvement in any of the following acts, even if federal or state law relieved you from reporting the detention, arrest, or conviction that arose from it.)
18

Murder, homicide, attempted murder or assault with the intent to commit murder
Yes No
19

Arson
Yes No
20

Assault with a deadly weapon
Yes No
21

Child abuse or molestation
Yes No
22

Forcible rape/Illegal sex acts
Yes No
23

Hate crime
Yes No
24

Perjury (lying under oath)
Yes No
25

Elder abuse (physical and/or financial)
Yes No
26

Possession of an explosive/destructive device
Yes No
27

Robbery (theft from another person using a weapon, force, or fear)
Yes No
28

Domestic violence
Yes No
29

Kidnapping
Yes No
30

Embezzlement
Yes No
31

Manufacture/Cultivation of a controlled substance
Yes No

 

Have you ever used or experimented with any of the drugs listed below? This includes the unauthorized or illegal use of prescription medications. If you answered yes, please give the most recent date used (mm/dd/yyyy).

Your response should include but not be limited to your use of the following:
32

Amphetamines/Methamphetamines (Uppers, Speed, Crank etc.)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
33

Barbiturates (Downers)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
34

Cocaine/Crack Cocaine
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
35

Designer Drugs (Ecstasy, Synthetic Heroin, etc.)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
36

GHB (Date Rape Drug)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
37

Hallucinogens (Peyote, LSD, Mushrooms)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
38

Hashish/Hashish Oil
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
39

Heroin/Opium
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
40

Marijuana
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
41

Mescaline
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
42

Morphine
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
43

PCP/Angel Dust
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
44

Quaaludes
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
45

Steroids
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
46

Tetrahydrocannabinal (THC)
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
47

Glue, paint, or any substance containing Toluene
Yes No
 

If you answered yes, please give the most recent date used (mm/dd/yyyy).
48

Have you used any illegal drugs that is not included in this list?
Yes No
 

If you answered yes, please provide the name of the drug(s) and the most recent date used (mm/dd/yyyy).

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