INSTRUCTIONS: The purpose of the Minimum Qualification Supplemental Questionnaire is to assess whether the applicant meets the minimum qualifications for the classification. The minimum qualifications have been identified as critical for satisfactory performance in this classification. The information provided must be consistent with the information on your application and is subject to verification. The responses on the Minimum Qualification Supplemental Questionnaire are mandatory for participation in this recruitment process.
Responses to items on the Minimum Qualification 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.
All experience and education referenced in this questionnaire MUST also appear in the work history and/or education sections of your application. The information provided must be consistent with the information on your application and is subject to verification. Please do not write, "See Application" or "See Resume" as a response. Resumes will not be reviewed.
NOTE: Falsifying one's education, training, or work experience or attempted deception on the application or Supplemental Questionnaire may result in disqualification for this and future job opportunities with the City and County of San Francisco.
As a reminder, all qualifying education 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 and experience you are about to describe in your application, you will not receive credit for this education and experience. If you are copying an old application please take time to update your application before submitting your application.
1.
Indicate the amount of verifiable experience you have performing a combination of at least two of the following duties:
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 possess none of this experience.
I possess some, but less than 6 months of this experience.
I possess 6 to 11 months of this experience.
I possess 1 year or more of this experience.
2.
Which year(s) you gained the experience above? Please check all that apply.
N/A - I do not possess the experience in the question above.
2015 and/or prior
2016
2017
2018
2019
2020
3.
Indicate the experience(s) you possess from question 1. Please check all that apply.
N/A - I do not possess any of the experience indicated.
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.
4.
Do you possess a Community Health Worker Certificate from City College of San Francisco?
Yes
No
5.
Do you possess a valid California Driver's License?
Yes
No
CERTIFICATION: I hereby certify that I am the author of this supplemental questionnaire and that all information is true and based on my education, training, skills, and experience. I understand that any false or incorrect statement may result in my disqualification from the selection process for this position and/or dismissal from employment with the City and County of San Francisco. I understand and agree that any information provided is subject to verification.
Department of Human Resources