Official SealHillsborough County Government


#1904-TRTCOUCPR4-001
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.



 

Select the highest level of completed education relevant to this position.

Master's degree in Social or Behavioral Science or related field
Bachelor's degree in Social or Behavioral Science or related field
Associate's degree in Social or Behavioral Science or related field
High School Dipolma/GED
None of the Above
 

Select the years of experience you have in mental health counseling, rehabilitation counseling or clinical social work.

More than 7 years
5-6 years
3-4 years
1-2 years
None of the Above
 

Are you a licensed clinical social worker?

Yes No
 

If you selected "No" to the above question, are you licensed eligible?

Yes
No
I am currently licensed
 

Are you able to work evenings, weekends, holidays, and on call which is required for this position?

Yes No
 

Select the years of experience you have working with mental health related issues, complex trauma, substance abuse and court involved youth in the welfare system.

More than 4 years
3 years
2 years
1 year
None of the Above
 

Describe your experience developing and implementing treatment plans.

 

Select the years of experience you have in case management.

More than 4 years
3 years
2 years
1 year
None of the Above
 

Describe your case management experience.

 

Select the years of experience you have facilitating small groups and workshops.

More than 4 years
3 years
2 years
1 year
None of the Above
 

Describe your experience facilitating small groups and workshops.

 

Describe your experience collaborating with caregivers, staff, internal/external agencies in order to effectively assess client behaviors, environmental factors and staff responses.

 

Do you possess a valid Driver’s License?

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.