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Santa Cruz County Personnel Department
#24-SL6-AA


Supplemental Questionnaire

Last Name First Name
 
 

Do you possess the following experience?

Master’s degree or PhD with a major in social work, psychology, clinical counseling, psychiatric nursing or a closely related behavioral science field which has included completion of a university approved internship, preferably a clinical internship, in a mental health agency. AND One year of full-time experience as a Senior Mental Health Client Specialist I at the County of Santa Cruz or equivalent experience.
Possession of a master’s degree or PhD with a major in social work, psychology, clinical counseling, psychiatric nursing or a closely related behavioral science field which has included completion of a university approved internship, preferably a clinical internship, in a mental health agency. AND Three years’ experience in crisis intervention as a Mental Health Client Specialist
I do not have thie experience
 

Do you possess any of the following licenses: 

Clinical Social Worker
Marriage and Family Therapist
Licensed Professional Clinical Counselor
Clinical Psychologist
I do not possess any of these licenses
 

Do you have experience providing mental health services for adult clients? 

6-12 months experience
13-24 months experience
25-36 months experience
I do not have this experience
 

Are you a certified Alcohol and Drug certified counselor? 

Yes
No
 

Do you have experience providing mental health services for children or youth clients? 

6-12 months experience
13-24 months experience
25-36 months experience
I do not have this type of experience
 

Do you have experience providing substance abuse counseling services to clients for drug and/or alcohol
issues?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have this experience
 

Do you have experience in a locked psychiatric facility? This can include psychiatric hospitals or Institutes for Mental Disorder (IMD) facilities?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have any experience in a locked psychiatric facility
 

Do you have experience providing mental health and/or substance abuse services in criminal justice settings such as juvenile hall, California Youth Authority, county jail, prison, or program serving adult or youth probationers?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have experience in this type of setting
 

Do you have experience providing Residential Mental Health Treatment? This includes mental health and/or substance abuse settings, such as group homes, sub-acute residential treatment, social rehabilitation, and dual diagnosis (mental health and substance abuse) residential programs (Does not include residential services for developmentally delayed population; for persons applying for drug and alcohol services may include substance abuse treatment settings)?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have experience in this type of setting
 

Do you have experience providing mental health and/or substance abuse services in community settings, such as client’s home, park, etc. (not in the office or clinic setting)?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have experience providing these services away from an office or clinic setting
 

Do you have experience Providing crisis services in community response teams, walk in clinics, crisis lines, forensic settings (such as juvenile halls, jails, and co-response with law enforcement)?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have this experience
 

Do you have experience placing hostile, distressed and/or acutely psychiatrically symptomatic persons on a 5150/5585 hold and/or assessing hostile, distressed and/or acutely psychiatrically symptomatic person to determine if they need to be psychiatrically hospitalized?

6-12 months experience
13-24 months experience
25-36 months experience
I do not have experience assessing for psychiatric hospitalization
 

Do you have experience conducting and documenting psychosocial evaluations/assessments including recommending Diagnostic and Statistical Manual (DSM) diagnosis? 

6-12 months experience
13-24 months experience
25-36 months experience
I do not have this experience
 

Do you have experience providing mental health and/or substance abuse services with co-workers from different disciplines (psychiatrists, consumer employees, therapists, case managers, social workers, public guardians, probation officers, teachers, school psychologists, law enforcement officers, and/or different agencies)? 

6-12 months experience
13-24 months experience
25-36 months experience
I do not have experience with multidisciplinary team collaboration
 

All the information provided is true and accurate. I understand that misrepresenting my experience will result in automatic disqualification from the recruitment process. 

Yes
No