Department of Human Resources

Minimum Qualification Supplemental Questionnaire

Medical Social Work Supervisor

CBT-2924-107400

All applicants are required to complete the Minimum Qualification Supplemental Questionnaire as part of the online application process. Insufficient or non-responsive answers or to the Supplemental Questionnaire may result in ineligibility, disqualification, or lower scores. 

Responses to items on the Supplemental Questionnaire must be supported by the information provided on the application in order to receive appropriate credit. Please provide a response to each question below to the best of your ability. Please provide all information requested even of the information may appear redundant.   Do not write, “See application” or “See resume.”

All education and experience referenced in this questionnaire MUST also appear in the work history and/or in the education sections of your application. A resume will not substitute for this supplemental questionnaire or for a completed application. 

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

Please indicate the selection that best matches your HIGHEST educational attainment.

I possess a current licensure as a Clinical Social Worker (LCSW) issued by the State of California Board of Behavioral Sciences as required under Title 22, California Administrative Code, Section 70055.

How much verifiable post-Master’s Medical Social Worker experience do you have supervising medical social workers in a medical social service program in a healthcare setting (such as a licensed hospital, licensed home health agency, or licensed healthcare community and ambulatory center) meeting the regulatory requirements of the State of California?

Supplemental Questionnaire Training and Experience Evaluation (SQT&E)

Medical Social Work Supervisor

CBT-2924-107400

The purpose of this Training and Experience Evaluation is to determine whether you meet the required licensure and to determine your knowledge, skills and abilities in job-related areas that have been identified as critical for satisfactory performance in the 2924 Medical Social Work Supervisor position.

The information provided should be consistent with the information on your application and is subject to verification. Verification of work experience may be collected at any time during or after the selection process.

Please choose the best answer for the questions below:

I possess the following experience and License and Certification:

Experience

Four (4) years of post-Master’s Medical Social Worker experience in a health care setting.               

License and Certification

Current licensure as a Clinical Social Worker (LCSW) issued by the State of California Board of  Behavioral Sciences as required under Title 22, California Administrative Code, Section 70055.

1a.If you answered “Yes” to Question 1 above, please provide your License and/or Certification number, your name as it appears on your License and/or Certification, and the expiration date of your License and/or Certification.

Please identify the amount of verifiable work experience you have post-Master’s Medical Social Worker experience in a health care setting.

(2,000 work hours equal one year)

Please provide a brief description of verifiable work experience providing post-Master’s Medical Social Worker experience in a health care setting to Older Adults and/or Dependent Adults and/or Adults with physical, cognitive or mental health disabilities.

Include in your answer your specific role and primary duties and responsibilities.

In accordance with your response to Question 2a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information. If no experience, type “none.”

Please identify the amount of verifiable work experience as a Medical Social Worker you possess coordinating Social Services Programs between social service staff and various hospital departments and community agencies.

(2,000 work hours equal one year)

Please provide a brief description of verifiable experience as a Medical Social Worker coordinating Social Services Programs between medical social service staff and various hospital departments and community agencies.

Please describe your most challenging social services program you coordinated.

Include in your answer the following:

What was the issue(s) or obstacle(s)?

Who were the stakeholder?

What agencies were involved?

Describe the steps you took to coordinate and deliver program services.

What was the outcome?

In accordance with your response to Question 3a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information. If no experience, type “none.”

Please identify the amount of verifiable work experience you possess as a Medical Social Worker coordinating and providing services to Older Adults/ or Dependent Adults and/or Adults with physical, cognitive or mental health disabilities.

 (2,000 work hours equal one year)

Please describe a time when you trained a staff member/coworker on a new process.

Include in your answer the following:

What was the new process?

Describe the steps you took to train the staff/co-worker on a new process

How did you ensure understanding?

What was the outcome?

In accordance with your response to Question 4a above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information. If no experience, type “none.”

Please describe a time when you trained a staff member/coworker on a new process.

Include in your answer the following: 

What was the new process? 

Describe the steps you took to train the staff member/co-worker on a new process.

How did you measure and ensure understanding?

What was the outcome?

In accordance with your response to Question 5 above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information. If no experience, type “none.”

Please identify the amount of verifiable work experience you possess supervising professional and other ancillary staff in a health care setting.

(2,000 work hours equal one year)

In accordance with your response to Question 6 above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the work experience. In addition, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided, as well as their contact information. If no experience, type “none.”