Department of Human Resources

2430 Medical Evaluations Assistant (TEX-2430-092043)

Minimum Qualifications/Training and Experience Supplemental Questionnaire

The purpose of this supplemental questionnaire is to assist in determining if you meet the specified minimum qualifications of the position. Additional questions provide a scoring mechanism for each instance of training and experience you have in this classification. All applicants are required to complete this supplemental questionnaire as part of the online process and the information you provide must be consistent with the information listed on your online application.  The supplemental questionnaire does not substitute for the online application.  All statements are subject to verification. No changes can be made to the Supplemental once submitted.

Please provide all the information requested even if it may appear redundant. Do not write "See application" or "See resume" as a response.

Do you possess a recognized Medical Assistant Degree or Certificate?

If you answered "Yes" to question 1A, please provide the name of the school where you obtained your degree or certificate, as well as the date that you obtained it.

If you do not possess a recognized Medical Assistant Degree or Certificate, please type "N/A."

Please indicate if you have completed any of the following training programs:

If you indicated that you have completed a training program in question 2A, please provide the name of the school where you completed your training program, as well as the date of completion.

If you indicated that you have completed an “Other training program," please provide the name of the school where you completed your "Other training program," date of completion, name of training program, and describe the specific program.

If you selected "I have not completed a training program," please type "N/A."

Do you possess a valid Certified Phlebotomy Technician I (CPT-1) certificate, issued by the State of California Department of Health Services?

If you answered "Yes" to question 3A, please provide your Certified Phlebotomy Technician I (CPT-1) certificate number, your name as it appears on your CPT-1 certificate, the date you obtained your certificate, and the expiration date of your certificate. (e.g. Certificate #: CPT33344433, Maggie Smith, License Obtained Date: 7/11/11, License Expiration Date: 7/11/13).

If you do not currently possess a valid CPT-1 certificate, please type "N/A."

Please indicate how much experience you have performing work as a Medical Evaluations Assistant. (One year is equivalent to 2,000 hours)

Please list the employer(s) where you gained this experience. (This must match what you have entered on the Employment History section of the application).

How long have you had a CPT1 certificate from the State of California?

Please indicate all the types of medical tests you have administered as a MEA, under the direction of a provider.

Please indicate how much experience monitoring telemetry for arrhythmia do you have?

Please indicate the areas you have provided specific health information to clients. (Check all that apply)

Please indicate what types of environments have you performed Medical Evaluations Assistant duties: (Check all that apply)

Please name all the employer(s) of above checked settings. (This must match what you have entered on the
Employment History section of application)

I hereby certify that I am the author of this application 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.