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Human Capital Management
#190307-H26A-05


Supplemental Questionnaire

Last Name First Name
 

 

OK Department of Human Services (DHS) requires that the following questions be answered before continuing with the application.


1.

Do you have legal status to work in the United States?

Yes No
2.

Have you had a protective order entered against you pursuant to the Oklahoma
Protection from Domestic Abuse Act or a similar statute of another state? 

If yes, provide the name of the court and court number in the text area:

If no, please enter No in the text area:            

3.

DHS policy does not allow some family members to be employed within the same supervisory group or unit. Please list the names of all of your relatives now employed by DHS:

If no, please enter No in the text area:

4.

Have you ever been terminated or resigned from employment in lieu of being terminated?  
If yes, explain circumstances:      

If no, please enter No in the text area:

 
Do you have a bachelor's degree?
Yes No

 

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 researching and gathering information?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 areas in which you have taken college classes.

sociology
psychology
social work
gerontology
human relations
death/grief
criminal justice
pre-law
accounting
I have not taken classes in any of the areas listed above.
 

Please list the school and location 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 computer programs you have experience using.

Microsoft Word or similar word processing software
Microsoft Excel or similar spreadsheet software
Microsoft Outlook or similar email program
I have no experience with any of the above.
 

Please list the school and location or 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 using a computer to gather information and draft written documents?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 planning, developing and organizing all phases of your own work?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 in mediation or conflict resolution?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 is your highest level of experience in working as part of a team?

I have led a team or group project.
I have been a member of a team or group project.
I have never been a part of a team or group project.
 

Please list the school and location or 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 is your experience providing customer service to the public?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education 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 reading, interpreting, and following detailed instructions?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 preparing written reports?

I have written reports as a regular part of my job.
I have written reports for a college course.
I am faimilar with this task or have received some training on it.
I have no experience with report writing.
 

Please list the school and location or 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 experiene do you have conducting multiple tasks simultaneously and meeting firm deadlines for those tasks?

I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training or education on it.
I have no experience with this task.
 

Please list the school and location or 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 populations of people with which you have experience working.

adults with mental illness
adults with cognitive impairments
adults with physical or mental limitations
adults with intellectual or developmental disability
adults with communications impairments
adults with chronic and terminal illness
adults with traumatic brain injuries
adults with mobility issues
adults with substance abuse issues
adults who have experienced domestic violence
adults who are unable to provide self-care
adults who are homeless
I have none of the experience listed above.
 

Please list 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.