Supplemental Questionnaire

	Placer County Human Resources Department

	#2022-14330-01
	Supplemental Questionnaire


Last Name	First Name

Psychiatric Nurse - II

2022-14330-01

This is the supplemental questionnaire for the classification of Psychiatric Nurse - II. Part I will not be scored or used for determining minimum qualifications but is provided for the applicant to review prior to completing the questionnaire and may also be used when determining assignment. Part II will be scored based on your checked responses.

By continuing in this examination process, you are certifying that all information provided in the supplemental questionnaire is true to the best of your knowledge. If selected for an interview, you may be required to display and respond to questions to validate your responses to this exam.

NOTE: Resumes, letters, and other materials will not be evaluated nor considered as responses to the items in this supplemental questionnaire. In addition, responses to this questionnaire will not be used for determining minimum qualifications for this position.

I have read and understood the above information.

Part I: Minimum Qualifications (Not Scored)

This section will not be scored but may assist the applicant with determining how he/she meets the minimum qualifications for this position.

Do you possess the equivalent of a bachelor's degree from an accredited college or university with major course work in nursing or a related field?

Yes No

Do you possess a valid license as a Registered Nurse issued by the California Board of Registered Nursing?

Yes No

If yes, please provide the license number and issue date.

Do you possess two years of responsible professional psychiatric nursing experience performing duties similar to a Psychiatric Nurse I with Placer County?

Yes No

Part II: Relevant Knowledge and Experience (Scored)

This section of the supplemental questionnaire is the Civil Service examination for this position. This supplemental questionnaire will be scored based on your checked responses below. Narratives provided by applicants describing training and/or experience will not be scored, but will be available to the hiring authority and may be utilized for interview and selection determination. Scores received from this section will determine applicant ranking and placement on the eligible list.

For the items in this section, please indicate your level of training and experience and then provide a brief description of your related experience in the space provided.

Please select the settings where you have provided nursing care:

Hospital Setting

Outpatient Setting

Residential Setting

In-home Care Setting

None of the above

If you indicated any experience, please briefly describe below.

Describe your experience related to general nursing principles and practices.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Describe you experience related to psychiatric nursing principles and practices.

I have no or very limited experience or knowledge in this area.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have applied this knowledge or skill independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Describe your experience related to legal and regulatory issues involved in treating persons experiencing mentally illness.

I have no or very limited experience or knowledge in this area.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Describe your experience providing medication, counseling, and education to patients regarding the need, purpose, and side effects of prescribed medications.

I have no or very limited experience or knowledge in this area.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Please select the types of medication you have administered.

Oral

Injection

None of the above

Describe your experience administering psychotropic medications to patients.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Describe your experience overseeing medication crisis telephone calls and walk-ins.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have applied this knowledge independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Describe your experience interviewing, observing, and recording patients as a means of collecting psychosocial and/or medical history.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

10.

Describe your experience with respect to mental health procedures and practices relative to the delivery of psychiatric nursing care.

I possess no or very limited experience or knowledge in this area.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have applied this knowledge independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

11.

Describe your experience in crisis intervention and conflict resolution techniques, including management of assaultive behavior.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

12.

Describe your experience assisting in developing standards and procedures for medication monitoring by nursing staff.

I have no or very limited experience in performing this task.

I have some experience performing this task but would need additional training.

I have performed this task under close supervision.

I have performed this task independently under normal supervision.

I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.

If you indicated any experience, please briefly describe below.

Thank you for completing the examination portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

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