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Human Capital Management
#210222-X17B-02


Supplemental Questionnaire

Last Name First Name
 

 

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.



 

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 conducting inspections, surveys, and investigations of food establishments, lodging facilities, barber shops, public bathing places, schools, day care centers, nursing homes, hospitals, or other regulated facilities?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

2.

What experience do you have identifying public health hazards or environmental conditions that are detrimental to life and health?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

3.

What experience do you have responding to complaints concerning food borne illnesses, adulterated foods, food tampering, recalls, insect or rodent infestation, or other issues related to food establishments?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

4.

What experience do you have reviewing and acting on various epidemiological reports or complaints?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

 

5.

What experience do you have conducting environmental assessments and other surveys related to lodging, public bathing, or barber services?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

6.

What experience do you have performing inspections for lead contamination or other public health hazards?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

7.

What experience do you have providing emergency response services for complaints concerning food borne illnesses, fires in food establishments, accidents involving the transportation of food, incidents concerning food or water contamination, and power outages or natural disasters involving food products?

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 supervison.
I am familiar with this task or have received some education or training on it.
I have no experience with this task.
 

Please list the school 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. 

8.

What experience do you have conducting field tests for chemical sanitizing agents using thermocouples, thermometers, or other evaluative instruments?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

9.

What experience do you have collecting and transporting food samples as required to determine adulteration, contamination, sources of pollution, or microbiological quality?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

10.

What experience do you have maintaining the legal chain of custody to preserve evidentiary requirements?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

11.

What experience do you have maintaining the legal chain of custody to preserve evidentiary requirements?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

12.

What experience do you have conducting evaluations to determine imminent hazards to life or health which warrant the closure of a facility?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

13.

What experience do you have preparing records, reports, and correspondence concerning regulatory actions?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

14.

What experience do you have conducting follow-up inspections and surveys to ensure corrective actions have been taken and that public health hazards are eliminated?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

15.

What experience do you have providing assistance with developing and implementing county emergency response plans?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

16.

What experience do you have providing assistance with county bioterrorism training exercises or serving as a responder in case of terrorist events?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

17.

What experience do you have preparing and writing 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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

18.

What experience do you have making oral presentations?

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 education or training on it.
I have no experiene with this task.
 

Please list the school 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. 

19.

What experience do you have planning your daily activities?

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 education or training on it.
I have no experience with this task.
 

Please list the school 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. 

20.

Please check all of the following computer programs with which you have experience working.

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

Please list the school 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.