Official SealDepartment of Human Resources


#CBT-2903-903543
Supplemental Questionnaire

Last Name
First Name

 

2903 HOSPITAL ELIGIBILITY WORKER (CBT-2903-903543)

The purpose of this Minimum Qualification Supplemental Questionnaire (MQSQ) is to obtain specific information regarding your education and experience in relation to the minimum qualifications for the recruitment, as stated on the announcement and will be used as a tool to screen applications for minimum qualification requirements. This Minimum Qualifications Supplemental Questionnaire (MQSQ) must be completed and submitted online with the application at the time of filing. Responses to items on the MQSQ must be supported by the information provided on the application in order to receive appropriate credit. Please be sure to include ALL relevant education and experience in the work history and education sections of the application. The information provided must be consistent with the information on your application and is subject to verification.

Applicants who do not possess the required Minimum Qualifications as stated on the job announcement will not be allowed to participate in the selection process.

Note: Falsifying one's education, training, or work experience or attempted deception on the application or MQSQ may result in disqualification for this and future job opportunities with the City and County of San Francisco. 

All information provided is subject to verification.  VERIFICATION MAY BE REQUESTED AT ANY TIME.


1.

Based on your education, indicate the selection that best matches your HIGHEST educational attainment (DO NOT COUNT UNITS THAT ARE IN PROGRESS OR UNITS YOU DO NOT POSSESS)

As a reminder, ALL qualifying education and experience must be listed on the application in order to be considered in review of Minimum Qualifications. If you do not include the education you are about to describe in the education section of your application, you will not receive credit for this. If you are copying an old application, please take the time to update the education and work history before submitting your application.

Verification of the education you indicate may be requested at ANY TIME.  This includes, copy of transcripts and/or copy of degree. 

Note: Falsifying one's education, training, or work experience or attempted deception on the application or MQSQ may result in disqualification for this and future job opportunities with the City and County of San Francisco.

High School diploma or equivalent (GED or High School Proficiency Examination)
Some college and possess 1-14 semester units/1-21 quarter units of coursework from an accredited college or university
Some college and possess 15-29 semester units/22-44 quarter units of coursework from an accredited college or universty
Some college, successful completion of 30-59 semester units/45-89 quarter units from an accredited college or university
Some college, successful completion of 60-89 semester units/90-134 quarter units from an accredited college or university
Some college, successful completion of 90+ semester units/135+ quarter units from an accredited college or university
Completion of a Bachelor's Degree from an accredited college or university
Completion of a Master's Degree from an accredited college or university
Completion of a Ph.D. from an accredited college or university
None of the Above
2.

Please indicate the total amount of verifiable direct public contact clerical work experience you have performing ALL of the following duties.  (Note: 1 year of experience = 2,000 hours of experience)

  • Use of computer applications to input, retrieve and analyze information;
  • Working with diverse client population;
  • Performing responsibilities involving interviewing to acquire detailed personal or confidential information;
  • Interpreting and applying rules, regulations and policies;
  • Creating and processing documents related to financial or personal histories of clients; and
  • Assisting clients with the completion of forms or correspondence.

As a reminder, ALL qualifying education and experience must be listed on the application in order to be considered in review of Minimum Qualifications. If you do not include the experience you are about to describe in the experience section of your application, you will not receive credit for this. If you are copying an old application, please take the time to update the education and work history before submitting your application.  

Verification may be requested at ANY TIME

I have clerical work experience but not direct public contact clerical work experience
I have verifiable direct public contact clerical work experience performing some of these duties but not ALL of these duties
I have less than 6 months of verifiable direct public contact clerical work experience performing ALL of these duties: use of computer applications to input, retrieve and analyze information; working with diverse client population; performing responsibilities involving interviewing to acquire detailed and personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence.
I have at least 6 months but less than 1 year (2,000 hours) of verifiable direct public contact clerical work experience performing ALL of these duties: use of computer applications to input, retrieve and analyze information; working with diverse client population; performing responsibilities involving interviewing to acquire detailed and personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence.
I have at least 1 year (2,000 hours) but less than 2 years (4,000) of verifiable direct public contact clerical work experience performing ALL of these duties: use of computer applications to input, retrieve and analyze information; working with diverse client population; performing responsibilities involving interviewing to acquire detailed and personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence.
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable direct public contact clerical work experience performing ALL of these duties: use of computer applications to input, retrieve and analyze information; working with diverse client population; performing responsibilities involving interviewing to acquire detailed and personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence.
I have 3 years (6,000 hours) or more of verifiable direct public contact clerical work experience performing ALL of these duties: use of computer applications to input, retrieve and analyze information; working with diverse client population; performing responsibilities involving interviewing to acquire detailed and personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence.
3.

Indicate the total amount of verifiable experience you have determining eligibility for health and/or social services programs, loans, financial assistance, unemployment, or veterans benefits? (Note: 2,000 hours of experience = 1 year of experience)

As a reminder, ALL qualifying education and experience must be listed on the application in order to be considered in review of Minimum Qualifications. If you do not include the experience you are about to describe in the experience section of you application,you will not receive credit for this. If you are copying an old application, please take the time to update the education and work history section before submitting your application.

Verification may be requested at ANY TIME.

I do not have verifiable experience determining eligibility
I have some verifiable experience determining eligibility, but less than 6 months
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience determining eligibility
I have at least 1 year ( 2,000 hours) but less than 2 years (4,000 hours) of verifiable experience determining eligibility
I have 2 years or more (4,000 hours or more) of verifiable experience in determining eligibility
4.

Of the following, in what areas do you have experience determining eligibility?  Check ALL that apply to you.

As a reminder, ALL qualifying education and experience must be listed on the application in order to be considered in review of Minimum Qualifications. If you do not include the experience you are about to describe in the experience section of your application, you will not receive credit for this. If you are copying an old application, please take the time to update the education and work history section before submitting your application.

Verification may be requested at ANY TIME.

Health Programs
Social Services Programs
Loans
Financial Assistance
Unemployment Benefits
Veterans Benefits
None of the above
 

CERTIFICATION: By checking this box, I hereby certify that I am the author of the information supplied in this supplemental questionnaire.  I understand that any false or incorrect statements may result in my disqualification or dismissal from employment with the San Francisco Department of Public Health and City and County of San Francisco.  I also understand and agree that the information provided is subject to verification.