Official SealDepartment of Human Resources


#CBT-2930-903679
Supplemental Questionnaire

Last Name
First Name

 

2930 BEHAVIORAL HEALTH CLINICIAN (CBT-2930-903679)

SUPPLEMENTAL QUESTIONNAIRE/TRAINING AND EXPERIENCE EXAMINATION

 PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY

 YOUR EXAMINATION SCORES WILL BE DERIVED FROM YOUR RESPONSES 

The purpose of this Supplemental Questionnaire/Training and Experience Examination is to assist with assessing possession of the Minimum Qualifications for class 2930 Behavioral Health Clinician, as well as to determine knowledge, skills, and abilities in job-related areas that have been identified as critical for satisfactory performance. Please refer to the examination announcement for a more detailed description of these knowledge, skills, and abilities.

This Supplemental Questionnaire/Training and Experience Examination is weighted at 100%. Applications or additional attached documents (e.g., resumes, cover letters, letters of reference/recommendation, etc.) will NOT be considered during the scoring process. Insufficient or non-responsive answers may result in ineligibility, disqualification, or lower scores. Once submitted, applicant responses cannot be changed. Applicants must achieve a passing score in order to be ranked on the eligible list/score report. Successful applicants will be placed on the eligible list/score report, in rank order, according to their final score.

Applicants should allow ample time to submit application and Supplemental Questionnaire/Training and Experience Examination responses before the filing deadline. If applicants experience technical difficulties, they should make note of any error messages and contact the analyst before the filing deadline. Supplemental Questionnaire/Training and Experience Examination responses should be consistent with and supported by the information on your application (i.e. Professional Licenses, Certifications, or Registrations & Employment Record sections) and are subject to verification at any time.

As a reminder, all qualifying licensure, registration, certification, and experience should be listed in the application to be considered in review of Minimum Qualifications.  Attaching a resume does not substitute for submitting a completed application. The application’s Education, Professional Licenses, Certifications, or Registrations, and Employment Record sections should clearly demonstrate how applicants satisfy the Minimum Qualifications. Do NOT type “see resume” or leave the above-mentioned application sections blank. If you are copying an old application, please take the time to update applicable sections before submitting your application.


1.

Please identify the valid registration or license that you possess, issued by the California Board of Behavioral Sciences (BBS):

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

How much verifiable direct service experience do you have in a psychiatric, social work, and/or behavioral health role or capacity as an Associate Clinical Social Worker, Associate Marriage and Family Therapist, or Associate Professional Clinical Counselor?

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

I have some, but less than one (1) year of this experience
I have at least one (1) year, but less than two (2) years of this experience
I have at least two (2) years, but less than three (3) years of this experience
I have at least three (3) years, but less than four (4) years of this experience
I have at least four (4) years, but less than five (5) years of this experience
I have five (5) years or more of this experience
I don't have any of this experience
3.

How much verifiable direct service experience do you have in a psychiatric, social work, and/or behavioral health role or capacity as a Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Licensed Professional Clinical Counselor?

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

I have some, but less than one (1) year of this experience
I have at least one (1) year, but less than two (2) years of this experience
I have at least two (2) years, but less than three (3) years of this experience
I have at least three (3) years, but less than four (4) years of this experience
I have at least four (4) years, but less than five (5) years of this experience
I have five (5) years or more of this experience
I don't have any of this experience
4.

The City and County of San Francisco provides services for culturally diverse populations who experience health disparities and need culturally appropriate health care or human services.

Please identify all client/patient populations where you have at least 2,000 hours of professional experience providing direct service as a registered Associate Clinical Social Worker, Associate Marriage and Family Therapist, Associate Professional Clinical Counselor, or Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Licensed Professional Clinical Counselor. Select all that apply.

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

Children (under age 11)
Adolescents (ages 12 – 17)
Transitional age youth (ages 18 – 25)
Older adults (above age 55)
Families
Substance users
Homeless
Indigent
Seriously Mentally Ill
Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI)/gender non-conforming
Immigrants/refugees/people with limited English proficiency
Cognitively impaired
Forensic (e.g., justice system involved, contact with the criminal justice system, etc.)
Black, Indigenous, and People of Color (BIPOC)
Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)
None of the above
5.

The City and County of San Francisco provides culturally diverse services in many different settings.

Please identify all employment settings where you have at least 2,000 hours of professional experience as a registered Associate Clinical Social Worker, Associate Marriage and Family Therapist, Associate Professional Clinical Counselor, or Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Licensed Professional Clinical Counselor. Select all that apply.

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

Mental health/specialty clinic
Inpatient psychiatric unit/hospital
Psychiatric emergency room/crisis services
Primary care/specialty clinic
School-based services
Criminal justice
Client home/supportive housing
Residential treatment
Community based outreach
Long-term care (e.g., locked facility, board and care, skilled nursing facility, etc.)
Intensive case management
Substance use treatment program
Private Hospital/Private Practice
Public/Government Hospital
Veterans Administration
None of the above
6.

As a registered Associate Clinical Social Worker, Associate Marriage and Family Therapist, Associate Professional Clinical Counselor, or Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Licensed Professional Clinical Counselor, how much experience do you have working with community agencies, organizations, and groups that provide services to clients/patients and families/significant others?

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

I have some, but less than one (1) year of this experience
I have at least one (1) year, but less than two (2) years of this experience
I have at least two (2) years, but less than three (3) years of this experience
I have at least three (3) years, but less than four (4) years of this experience
I have at least four (4) years, but less than five (5) years of this experience
I have five (5) years or more of this experience
I don't have any of this experience
 

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.