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Human Capital Management
#191009-X31C-04


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 preparing and arranging comprehensive evaluation reports?

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 internship 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 write N/A below.

2.

What experience do you have planning, developing and organizing all phases of your own work?

I have performed this task as a regular part of my job.
I have performed this task as part of my job occasionally.
I have no experience with this task.
 

Please list the internship 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 write N/A below.

3.

How many years of experience do you have in counseling or conflict resolution?

I have 7 or more years of experience.
I have 4-6 years of experience.
I have 1-3 years of experience.
have no experience with this task.
 

Please list the internship 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 write N/A below.

4.

What experience do you have consulting with community service providers, clinicians, school personnel, and others on psychological issues?

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 internship 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 write N/A below.

5.

What experience do you have interviewing clients and contacts to gather information concerning psychological issues?

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 internship 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 write N/A below.

6.

Please check all types of tests you have experience administering.

Intelligence tests
Career or vocational tests
Developmental or behavioral assessments
Psychological tests
Alcohol and drug screening
I have experience with other types of tests not listed.
I have no experience administering tests.
 

Please list the internship 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 write N/A below.

7.

What is your experience developing treatment plans based on assessment results and interviews?

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 internship 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 write N/A below.

8.

What experience do you have compiling statistical data and other types of reports?

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 internship 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 write N/A below.

9.

Please check all participation you have had in meetings, conferences, training classes or seminars on psychological related issues.

I have attended meetings, conferences, training classes, or seminars on psychological related issues.
I have made poster presentations at meetings, conferences, training classes, or seminars on psychological related issues.
I have made audience presentations at meetings, conferences, training classes, or seminars on psychological related issues.
I have organized, developed, or coordinated conferences, training classes or seminars on psychological related issues.
I have not participated in any meetings, conferences, training classes or seminars on psychological related issues.
 

Please list the internship 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 write N/A below.

10.

Please check all types of psycho-educational programs with which you have facilitated.

Parenting workshops
Children's groups
Community outreach programs
Career or vocational programs
Substance abuse programs
Support groups
Treatment groups
I have facilitated other types of psycho-educational programs not listed.
I have no experience participating in psycho-educational programs.
 

Please list the internship 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 write N/A below.

11.

What experience do you have maintaining confidential files or information?

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 internship 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 write N/A below.

12.

What experience do you have establishing and maintaining partnerships with various agencies, public facilities, or organizations?

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 internship 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 write N/A below.

13.

What experience do you have working with clients from a variety of cultures?

I have worked with clients from a variety of cultures as a regular part of my job.
I have occasionally worked with clients from a variety of cultures.
I am familiar with or have received some training on working with clients from a variety of cultures.
I have no experience working with clients from a variety of cultures.
 

Please list the internship 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 write N/A below.

14.

Please check all of the following counseling services you have provided.

Family or marriage
Adolescent, infant, or early childhood
Geriatric
Educational, learning, or intellectual disabilities
Adult or youth corrections
Substance abuse
Physical or mental disabilities
I have no experience with any of the listed counseling services.
 

Please list the internship 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 write N/A below.

15.

Please check all of the following professional or psychological organizations to which you belong.

American Psychological Association
American Counseling Association
Behavior Analyst Certification Board (BACB)
National Rehabilitation Association
The Academy of Certified Social Workers (ACSW)
I belong to a professional or psychological organization not listed.
I do not belong to any professional or psychological organizations.
16.

What experience do you have working with people with mental or behavioral health issues?

I have worked with people with mental or behavioral health issues as a regular part of my job.
I have occasionally worked with people with mental or behavioral health issues.
I am familiar with or have received some training on working with people with mental or behavioral health issues.
I have no experience working with people with mental or behavioral health issues.
 

Please list the internship 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 write N/A below.

17.

What experience do you have preparing reports to be used in court?

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 internship 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 write N/A below.

18.

Do you currently hold a relevant certification?

Yes No
 

Please list the certifications you currently hold. If you indicated "no", then please write N/A below.