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Supplemental Questionnaire

Last Name
First Name







The purpose of this Supplemental Questionnaire is to assist with evaluating possession of the Minimum Qualifications(i.e. required education, experience, and licensure/certification) and Desirable Qualifications for the 2574 Clinical Psychologist position. This position requires bilingual fluency in Spanish and English.

IMPORTANT NOTE:  Attaching a resume does not substitute for submitting a completed application. Your application’s Education, Professional Licenses, Certifications, or Registrations, and Employment Record sections should clearly demonstrate how you satisfy this position’s Minimum Qualifications. Do NOT type “see resume” or leave the above-mentioned application sections blank.

It is suggested that you allow ample time to submit your application and Supplemental Questionnaire responses before the filing deadline. If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with and supported by the information on your application (i.e. Education, Professional Licenses, Certifications, or Registrations & Employment Record sections) and are subject to verification at any time.

As a reminder, all qualifying education, licensure, registration, certification, and experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the education, licensure, registration, certification, and experience you are about to describe in the applicable sections of your application, you will not receive credit. If you are copying an old application, please take the time to update applicable sections before submitting your application.


Please identify the valid California license that you possess:

I have a valid license in one of the required areas, but it is not issued by the State of California
Licensed Clinical Social Worker issued by the California Board of Behavioral Sciences
Licensed Marriage and Family Therapist issued by the California Board of Behavioral Sciences
Licensed Professional Clinical Counselor issued by the California Board of Behavioral Sciences
Psychologist license issued by the California Board of Psychology
None of the above

I have the ability to fluently communicate in Spanish and English and I understand that I must pass a bilingual proficiency test to be considered for bilingual positions.

Yes No

CERTIFICATION:  I understand that checking this box will serve as my electronic signature. I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience. I understand and agree that any information provided is subject to verification. I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.