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Santa Cruz County Personnel Department
#19-SK5-EE


Supplemental Questionnaire

Last Name First Name
 

 

The supplemental questions are designed specifically for this recruitment. Applications received without the required supplemental information will be screened out of the selection process. Employment experiences referred to in your response must also be included in the Employment History section of the application.

 Please answer the question(s) below as completely and thoroughly as possible, as your answer(s) may be used to assess your qualifications for movement to the next step in the recruitment process.

 


1.

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

2.

Describe your scope of experience (if any) providing mental health services for adults with serious mental illness.

3.

Describe your scope of experience (if any) providing mental health services for children/youth who have been diagnosed with an emotional disturbance and support services for their families.

4.

Describe your scope of experience (if any) providing substance abuse counseling services.

5.

Describe your scope of experience (if any) providing crisis services or mental health services in a forensic/criminal justice setting (such as juvenile hall, California Youth Authority, county jail, prison or programs serving 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 providing mental health services for children or youth clients?

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 mental health services for adult clients?

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 providing substance abuse counseling services for drug and/or alcohol issues?

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 services in locked psychiatric facilities (include psychiatric hospitals and Institutes for Mental Disorder)?

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 mental health and/or substance abuse 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
12.

How much experience, if any, do you have working in residential mental health or substance abuse 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
13.

How much experience, if any, do you have providing mental health or substance abuse 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
14.

How much experience, if any, do you have providing mental health or substance abuse services in a school setting, 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
15.

How much experience, if any, do you have placing hostile, distressed and/or acutely psychiatrically symptomatic persons on a 5150 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
16.

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

Less than 0.5 Months
0.5-5 Months
6-12 Months
13-24 Months
25-36 Months
17.

How much experience, if any, do you have providing mental health and/or substance abuse 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
18.

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

Adult Mental Health
Children/Youth Mental Health
Drug and Alcohol Services
Forensic Mental Health

 

(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 demonstrated on your application and supplemental application).