Department of Human Resources

0943 MANAGER VIII (PEX-0943-107595)

CHIEF MEDICAL OFFICER

LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER

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 education and experience) for the 0943 Manager VIII - LHH Chief Medical Officer 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.

Do you have a valid license to practice medicine issued by the Medical Board of California or the Osteopathic Medical Board of California?

Please identify the medical specialty area(s) for which you have valid Board Certification. Select all that apply.

Do you have valid Drug Enforcement Administration (DEA) registration with the United States Department of Justice?

How much post-residency, managerial experience do you have in planning, organizing, and evaluating medical services in a hospital, clinic, skilled nursing facility, or related health care setting?

One (1) year of experience is equivalent to 2,000 hours.

How much of your post-residency, managerial experience in planning, organizing, and evaluating medical services in a hospital, clinic, skilled nursing facility, or related health care setting included supervising employees?

One (1) year of experience is equivalent to 2,000 hours.