	Human Capital Management

	#180614-Z51C-03
	Supplemental Questionnaire


Last Name	First Name

*For the purposes of the Youth Guidance Specialist Job Family: Applicants must be a least twenty-one (21) years of age and possess a high school diploma or its equivalent (10 O.S. Section 401 et seq.).

*There is no substitution for the required one year of experience working with juveniles in a residential care and treatment center.

Are you twenty-one (21) years of age and possess a high school diploma or its equivalent?

Yes No

Do you have any of the following?

thirty (30) semester hours from an accredited college or university AND one year of experience working with juveniles in a residential care and treatment center

three (3) years of experience working with juveniles in a residential care and treatment center

a combination of college coursework from an accredited college or university AND a minimum of one year of experience working with juveniles in a residential care and treatment center that totals three (3) years

none of the above

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire. The questions below will be used for scoring purposes, in lieu of a written exam.

What experience do you have performing routine duties in the care, custody, education and treatment of juvenile offenders?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have managing aggressive and non-aggressive behavior of juvenile offenders through verbal and physical intervention using prescribed and approved techniques?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have observing, recording and reporting health symptoms, behavior, and activity of residents?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have providing paraprofessional counseling and instruction to residents by directing their daily activities, maintaining order, providing support, and helping them develop and achieve personal goals?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have serving as a group leader by reviewing and assessing the adjustment and functioning of a group of residents?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have inspecting living quarters to ensure health and safety standards are being met?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have controlling contraband in accordance with established procedures?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have controlling movement of residents to and from living quarters for activities and off-campus appointments?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have serving on a treatment team to review residents' progress, treatment and educational plans?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

What experience do you have handling inappropriate sexual behavior between staff and residents?

I have supervised others performing this task.

I have performed this task independently as a regular part of my job.

I have performed this task under supervision as a regular part of my job.

I am familiar with this task or have received some training on it.

I have no experience with this task.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

Please check all of the following supervisory tasks you have conducted.

Administering progressive discipline

Completing performance evaluations

Creating work schedules

I have no experience with any of the above.

Please list the employer and job title where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A below.

Please make sure that you attach all requested documents to your application, if requested. Resumes should be attached to the "Resume" tab and any other requested documents to the "Other" tab.