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Santa Cruz County Personnel Department
#19-NP5-01


Supplemental Questionnaire

Last Name First Name
 

 

THE SUPPLEMENTAL QUESTIONS ARE DESIGNED SPECIFICALLY FOR THIS RECRUITMENT. A RESPONSE TO THESE QUESTIONS MUST ACCOMPANY THE REGULAR APPLICATION TO BE CONSIDERED FOR THIS POSITION. APPLICATIONS RECEIVED WITHOUT THE REQUIRED SUPPLEMENTAL INFORMATION WILL BE SCREENED OUT OF THE SELECTION PROCESS. 

Employment, internship or volunteer experiences referred to in these responses MUST also be included in the Employment History section of the application. 


1.

Describe the population(s) to whom you have provided behavioral health and/or substance use disorders services and the types of settings in which you have provided those services.

 

2.

Detail your scope of experience providing behavioral health services for adults with serious mental illness.

3.

Detail your scope of experience providing behavioral health services for children/youth who are emotionally disturbed and their families.

4.

Detail your scope of experience providing substance use disorders counseling/treatment services.

5.

Describe your scope of experience in providing behavioral health and/or substance use disorders services in criminal justice/forensic settings such as juvenile hall, California Youth Authority, county jail, prison and/or for adult or youth probationers.

6.

Do you hold current certification as an Alcohol and Drug Counselor?

Yes No
7.

How much experience, if any, do you have in locked psychiatric facilities (includes youth and/or adult psychiatric hospitals and Institutes for Behavioral Health Disorder’s facilities)?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
8.

How much experience, if any, do you have providing behavioral health and/or substance use disorders services in criminal justice settings such as juvenile hall, California Youth Authority, county jail, prison or programs serving adult or youth probationers?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
9.

How much experience, if any, do you have in residential behavioral health or substance use disorders settings (not including residential services for developmentally delayed population)?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
10.

How much experience, if any, do you have providing behavioral health and/or substance use disorders services in community settings, such as client’s home, park, etc. (not in office, residential facility or clinic setting)?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
11.

How much experience, if any, do you have providing behavioral health and/or substance use disorders services in a school setting, community-based organization and/or primary care physician’s office or primary health clinic?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
12.

How much experience, if any, do you have placing hostile, distressed and/or acutely psychiatrically symptomatic persons on a 5150/5585 hold and/or assessing such patients to determine if they need to be psychiatrically hospitalized?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
13.

How much experience, if any, do you have conducting and documenting psychosocial evaluations/assessments, including recommending Diagnostic and Statistical Manual (DSM) diagnosis?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
14.

How much experience, if any, do you have providing behavioral health and/or substance use disorders services while collaborating with co-workers or representatives from different disciplines (psychiatrists, consumer employees, therapists, case managers, social workers, public guardians, probation officers, teachers, psychologists, law enforcement officers, and/or different agencies)?

Less than 0.5 Months
0.5 - 5 Months
6 - 12 Months
13 - 24 Months
25 - 36 Months
15.

Indicate the program area(s) of specialization for which you would like to be considered from the list below:

Adult Behavioral Health
Children/Youth Behavioral Health
Forensic Behavioral Health
Integrated/Primary Care Clinic Services
Substance Use Disorders Services *Please submit a copy of your Alcohol and Drug certificate or proof of registration if applicable.

 

(Note: Selective certification to positions will be based on the preference(s) you have indicated above along with the demonstrated working knowledge and abilities you have listed on your application and supplemental questions).