Official SealHillsborough County Government


#1903-YCSPECCPP2-002
Supplemental Questionnaire

Last Name
First Name

 

Supplemental Questionnaire


INSTRUCTIONS: Completion of this supplemental questionnaire is REQUIRED. Please read each question carefully and provide clear and complete responses that accurately portray your education and relevant work experience. Your qualifications for employment will be evaluated based upon the information you provide in your responses below and then verified by our staff who will review your entire application for completeness and determine qualification status.

The employers and dates of employment that you list on this supplemental questionnaire MUST match the employers and dates of employment provided in the work experience section of your employment application. Failure to provide matching employer, and dates of employment may result in your application being "not qualified" for this recruitment.

IMPORTANT NOTE: "See Resume" is not an acceptable response to any of the open-ended questions on this questionnaire and will result in your application being "not qualified" for this recruitment.



 

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

 

Master's Degree or higher major in Human or Social Services field
Bachelor's Degree major in Human or Social Services field
Associate's Degree in Human or Social Services field
60 credit hour in the field of Human or Social Services
High School Diploma/GED Certification
None of the above
 

Select the number of years of experience you possess working with youth as a counselor, recreational leader, teacher, instructor or as a care provider to emotionally, mentally, physically disabled youth, or at risk youth.

 

more than 7 years
5-6 years
3-4 years
1-2 years
No Experience
 

Do you possess a current and valid Driver's License?

 

Yes No
 

How many years of experience do you possess working in a 24-hour residential facility that houses at-risk youth or any affiliation with?

 

5 years or more
4 years
3 years
2 years
1 year
No Experience
 

Please describe your experience as it relates to the question above, otherwise type N/A.

 

 

How many years of experience do you have working with youth between 10 and 17 years old?

 

5 years or more
4 years
3 years
2 years
1 year
No Experience
 

Please describe your experience as it relates to the question above, otherwise type N/A.

 

 

Do you have experience in planning and implementing therapeutic interventions and/or constructive activities for children and adolescents?

 

Yes No
 

Please describe your experience as it relates to the question above, otherwise type N/A.

 

 

Do you possess a Certification or Knowledge of NAPPI (Non-Abusive Psychological and Physical Intervention)?

 

Yes No
 

Do you possess any certifications related to this position?

 

Yes No
 

List any certifications you possess related to this position, otherwise type N/A.

 

 

This position operates on a 24/7 basis with 12-hour shifts. Non-standard hours means that you may be required to work overnight from 6pm–6am, weekends, and/or holidays. Are you able to work non-standard hours, 12-hour overnight shifts (6 pm - 6 am), weekends, and holidays?

 

Yes No
 

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By checking the box above, I certify that all of my responses are true and complete, and any misstatement of material facts OR failure to completely answer questions or provide my employer with a copy of any licenses, certifications, or other documents listed on the job announcement will subject me to disqualification from the application process and/or dismissal from employment.

I also authorize investigation of all statements contained in my application, to include a formal background check that may require education and employment verification; criminal history; and motor vehicle driving report as may be necessary in arriving at an employment decision. Further, I acknowledge understanding that an offer of employment will be subject to successfully passing a drug screen and physical.

I also understand that once I submit my application for this recruitment, I cannot edit it later.