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#TPV-2932-107569
Supplemental Questionnaire

Last Name
First Name

 

2932 SENIOR BEHAVIORAL HEALTH CLINICIAN (TPV-2932-106496)

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/certification and experience) for the Primary Care Section's 2932 Senior Behavioral Health Clinician position.

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 Clinical Social Worker (ACSW), 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)
Current registration as an Associate Marriage and Family Therapist (AMFT), issued by the California Board of Behavioral Sciences (BBS)
Valid Professional Clinical Counselor (LPCC) license, issued by the California Board of Behavioral Sciences (BBS)
Current registration as an Associate Professional Clinical Counselor (APCC), issued by the California Board of Behavioral Sciences (BBS)
None of the above
2.

How much full-time post-Master's psychiatric Marriage, Family and Child Counselor (MFCC), Marriage, Family Therapist (MFT), Clinical Social Worker (LCSW) or Professional Clinical Counselor (LPCC) experience do you have in a psychiatric or medical setting?

Six (6) months of full-time experience is equivalent to 1,000 hours.

I have some, but less than six (6) months of this experience
I have at least six (6) months, but less than twelve (12) months of this experience
I have at least twelve (12) months, but less than eighteen (18) months of this experience
I have at least eighteen (18) months, but less than twenty-four (24) months of this experience
I have at least twenty-four (24) months, but less than thirty (30) months of this experience
I have at least thirty (30) months, but less than thirty-six (36) months of this experience
I have thirty-six (36) months of this experience or more
I don't have any of this experience
3.

How much clinical experience do you have working with children?

Six (6) months of full-time experience is equivalent to 1,000 hours.

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 used to fill other 2932 Senior Behavioral Health Clinician vacancies at various locations throughout the San Francisco Department of Public Health.  Please identify all 2932 Senior 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.