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Santa Cruz County Personnel Department

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.

NOTE: 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.


Describe your experience to demonstrate completion of internship and completion of psychiatric residency training approved by the American Medical Association or the American Osteopathic Association.


Please indicate if you have experience in any of the following areas: Leadership roles such as a Chief Resident or Medical Director; consultation/liaison psychiatry, substance abuse, forensic (working with patients in juvenile hall, jail, prison, or on probation, etc), older adults (age 60 and above), transitional age youth (ages 18-24), seriously mentally ill adults, children and youth, outpatient or inpatient psychiatry.


Please submit any required certification(s) in one of the following ways:

Upload online with your application (OTHER Tab)
fax: 831-454-2411
hand deliver or mail: 701 Ocean Street, Room 510, Santa Cruz, CA 95060