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Human Capital Management
#190111-H20C-01


Supplemental Questionnaire

Last Name First Name
 

 

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.


1.

What experience do you have providing social services to clients and arranging needed treatment or services?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 

2.

What is your experience counseling individuals under the direction of a psychiatrist, psychologist, or other social services specialist?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
3.

What experience do you have assessing the needs of individuals and determining eligibility for specific programs?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
4.

What experience do you have developing and planning casework services and treatment for individuals with specialized needs or disabilities?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
5.

What experience do you have developing and implementing specialized programs within the community?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
6.

What experience do you have providing training in caseload principles and practices and ensuring compliance with federal and state regulations, and agency policies and procedures?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
7.

What experience do you have coordinating an interdisciplinary treatment team?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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.

8.

Please check all experience you have managing caseloads.

I have supervised others who manage caseloads.
I have trained other professionals to manage a caseload.
I have effectively managed a caseload.
I have no experience managing caseloads.
 
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. 
9.

What experience do you have coordinating service delivery?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 

10.

What is your experience coordinating and monitoring Medicaid eligibility?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
11.

What experience do you have preparing written reports?

I have supervised others performing this task, and I have performed this task as part of my job.
I have supervised others performing this task, but I have not performed this task as part of my job.
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
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. 
12.

What experience do you have reviewing and analyzing an employee’s productivity?

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

13.

What experience do you have writing, revising, and reviewing an employee’s annual performance evaluation?

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