Official SealHillsborough County Government


#1907-ATDCADCOS1-004
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 your highest level of completed education.

Associates Degree or higher
High School Diploma/GED Certification
Completion of the 10th grade
None of the above
 

Do you possess a current Cardiopulmonary Resuscitation (CPR) Certification?

Yes No
 

Do you possess a valid Driver’s license?

Yes No
 

Select the number of years of experience you possess communicating and working with older adults, frail, or persons with dementia or Alzheimer’s.

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

Select the number of years of experience you possess implementing and orchestrating the day’s activities that are therapeutic in nature, i.e. art, exercise, music, activities involving hand-to- eye coordination, cognitive activities, and sensory activities.

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

Describe your experience implementing and orchestrating the day’s activities that are therapeutic in nature, i.e. art, exercise, music, activities involving hand-to- eye coordination, cognitive activities, and sensory activities.

Indicate N/A if you do possess this experience.

 

Have you completed an Alzheimer’s Disease and/or Related Disorders Training within the last year?

Yes No
 

This position will work up to 30 hours per week. Would you be willing to accept this condition if selected?

Yes No
 

Are you willing to accept an hourly wage of $11.54?

Yes No
 

Do you have reliable transportation to/from work sites?

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.