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#TPV-2587-107157
Supplemental Questionnaire

Last Name
First Name

 

2587 Health Worker 3 (TPV-2587-101555)

The purpose of this Supplemental Questionnaire is to determine if you meet the minimum qualifications of the position.  The information you provide to the following questions does not substitute for the online application, and all information provided MUST be consistent with the information listed on your application. You must still complete all sections of the online application. Please be sure to update all sections of your application prior to submission.

All information provided is subject to verification.  Please do not write, "See Application" or "See Resume" as a response. Resumes will not be reviewed.


1.

How much verifiable experience do you have performing a combination of at least two (2) of the following duties WITHIN THE LAST FIVE (5) YEARS? (Note: One year is equal to 2,000 hours)

  • Serving as a liaison between targeted communities and health care agencies;
  • providing culturally appropriate health education/information and outreach to targeted populations;
  • providing referral and follow up services or otherwise coordinating care;
  • providing informal counseling, social support and advocacy to targeted populations;
  • escorting and transporting clients;
  • providing courier /dispatcher functions;
  • performing pre-clinical examinations of vital statistics, such as measuring a patient’s weight, height, temperature and blood pressure.

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

I do not have any experience.
I have 5 months or less of experience.
I have 6 months to 11 months of experience.
I have 1 year to 1 year, 11 months of experience.
I have 2 years to 2 years, 11 months of experience.
I have 3 years to 3 years, 11 months of experience.
I have 4 years to 4 years, 11 months of experience.
I have 5 years or more of experience.
1A.

For the experience you indicated above, please select the the work duties you have performed. 

Serving as a liaison between targeted communities and healthcare agencies.
Providing culturally appropriate health education/information AND outreach to targeted populations.
Providing referral and follow up services or otherwise coordinating care.
Providing informal counseling, social support and advocacy to targeted populations.
Escorting and transporting clients.
Providing courier/dispatcher functions.
Performing pre-clinical examinations of vital statistics, such as measuring a patient's weight, height, temperature and blood pressure.
I have not performed any of the duties listed above.
2.

Are you bilingual proficient in English and Cantonese

 

Yes No
3.

Do you possess a Community Health Worker Certificate from City College of San Francisco?

Yes No
4.

CERTIFICATION:  By checking this box, I certify that I am the author of this application and supplemental questionnaire and that all information is true based on my background, skills and experiences.  I understand that any false, incomplete or incorrect statement, regardless of when it was discovered, may result in my disqualification or dismissal from my employment with the City and County of San Francisco.  I understand and agree that any information provided is subject to verification.