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#TPV-2930-106436
Supplemental Questionnaire

Last Name
First Name

 

2930 BEHAVIORAL HEALTH CLINICIAN (TPV-2930-106436)

BILINGUAL CANTONESE/ENGLISH & CLINICAL EXPERIENCE WITH CHILDREN

MINIMUM QUALIFICATION SUPPLEMENTAL QUESTIONNAIRE

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY

The purpose of this Supplemental Questionnaire is to assist with evaluating possession of the Minimum Qualifications(i.e. required license/registration and experience) for the Chinatown Child Development Center and Family Mosaic Project's 2930 Behavioral Health Clinician positions.  These positions require bilingual fluency in Cantonese and English as well as twelve (12) months of clinical experience with children.

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.


1.

Please identify the valid license or registration that you possess, issued by the California Board of Behavioral Sciences (BBS):

Valid Licensed Clinical Social Worker (LCSW) license issued by the California Board of Behavioral Sciences (BBS)
Current registration as an Associate Social Worker (ASW) license issued by the California Board of Behavioral Sciences (BBS)
Valid Marriage and Family Therapist (MFT) license issued by the California Board of Behavioral Sciences (BBS)
Valid Marriage and Family Therapist Intern (MFTI) license issued by the California Board of Behavioral Sciences (BBS)
Valid Professional Clinical Counselor (LPCC) license issued by the California Board of Behavioral Sciences (BBS)
Valid Professional Clinical Counselor Intern (PCCI) license issued by the California Board of Behavioral Sciences (BBS)
None of the above
2.

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

 

Yes No
3.

How much clinical experience do you have working with children?

I have experience working with children, but it was not clinicial
I have some, but less than 6 months of this experience
I have at least 6 months, but less than 12 months of this experience
I have at least 12 months, but less than 18 months of this experience
I have at least 18 months, but less than 24 months of this experience
I have at least 24 months or more of this experience
I don't have any of this experience
4.

The qualified applicant pool resulting from this recruitment may be utilized to fill other 2930 Behavioral Health Clinician vacancies at various locations within the Department of Public Health.  Please identify all 2930 Behavioral Health Clinician positions for which you'd like to be considered.  Select all that apply.

Full-time positions (i.e. 40 hours/week)
Part-time positions (i.e. fewer than 40 hours/week)
As needed positions (e.g. on call, float pool, etc.)
None of the above
 

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.