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#CBT-2322-113641
Supplemental Questionnaire

Last Name
First Name

 

2232 Nurse Manager

Specialty: Ambulatory Care

 Supplemental Questionnaire

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY AS THEY CONTAIN IMPORTANT INFORMATION:

The purpose of this Supplemental Questionnaire is to determine if you meet the minimum qualifications of a 2322 Nurse Manager in the Ambulatory Care specialty, and to determine your knowledge, skills, and abilities in job-related areas that have been identified as critical for satisfactory performance in this specialty.

Responses to supplemental questionnaire items must be supported by the information provided in the body of your application (i.e. Higher Education; Professional Licenses, Certifications, or Registrations; Employment Record) in order to receive appropriate credit, and are subject to verification. Verification of experience, licensure, and possession of valid certifications/certificates may be collected at any time during or after the selection process.

INSTRUCTIONS: Please answer all applicable questions by choosing the best response that matches your education, experience, certifications, licenses, and/or by providing the information requested.



 

Part OneEducation & Experience Qualifications

Instructions For Questions 1 - 4:

Please answer all applicable questions by choosing the best response that matches your education, experience, certifications, and licenses.


1.

Do you possess a valid permanent/temporary (including interim permit) California Registered Nurse License issued by the California Board of Registered Nursing?

As a reminder, all licenses must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the "Professional Licenses, Certifications or Registrations" section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update the appropriate section before submitting your application.

Yes No
2.

What is the highest level of education that you have completed?

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

Associate degree in Nursing (ASN/ADN)
Bachelor of Science degree in Nursing (BSN)
Master of Science degree in Nursing (MSN)
PhD. or DNP in Nursing
None of the above
3.

How much verifiable full-time equivalent work experience do you possess as a Registered Nurse in a general acute care hospital in a medical or surgical unit within the last five (5) years? (Full-time experience is equivalent to 40 hours per week.)

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

I have NO verifiable experience.
I have some verifiable experience, but less than 1 year (<1,999 hours) of verifiable experience.
At least 1 year but less than 2 years (2,000 to 3,999 hours) of verifiable experience.
At least 2 years but less than 3 years (4,000 to 5,999 hours) of verifiable experience.
At least 3 years but less than 4 years (6,000 to 7,999 hours) of verifiable experience.
At least 4 years but less than 5 years (8,000 to 9,999 hours) of verifiable experience.
5 years or more (10,000 hours or more) of verifiable experience.
4.

How much verifiable full-time equivalent experience do you possess working as a charge nurse, assistant nurse manager, or nurse manager in a surgical or Ambulatory setting? (Full-time experience is equivalent to 40 hours per week.)

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

I have NO verifiable experience.
I have some verifiable experience, but less than 1 year (<1,999 hours) of verifiable experience.
At least 1 year but less than 2 years (2,000 to 3,999 hours) of verifiable experience.
At least 2 years but less than 3 years (4,000 to 5,999 hours) of verifiable experience.
At least 3 years but less than 4 years (6,000 hours to 7,999 hours) of verifiable experience.
4 years or more (8,000 hours or more) of verifiable experience.

 

Part Two: Supplemental Questionnaire

Instruction for Questions 5 - 10:

All applicants are required to complete the supplemental questionnaire as part of the online application process. The questionnaire will be used to assess each candidate’s possession of the minimum qualifications and their knowledge, skills and abilities as it pertains to the position.

Responses to items on the supplemental questionnaire must be supported by the information provided on the application. This information is subject to verification. Please be sure to include all relevant education and experience in the work history and education sections of the application. Resumes are not used or reviewed to determine whether you meet the minimum qualifications or to determine your score/rank. A resume should not be submitted to substitute for a completed application. If you write "see resume" on the application, or on the supplemental questionnaire, your application may be rejected.

If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with the information on your employment application and are subject to verification.

By continuing, you hereby certify that you are the author of the information supplied in this supplemental questionnaire.  You understand that any false or incorrect statements may result in your disqualification or dismissal from employment with the San Francisco Department of Public Health and City and County of San Francisco.  You also understand and agree that the information provided is subject to verification.


5A.

Which of the following electronic medical records software systems do you have experience using?

Invision/LCR
ECW
JIM
EPIC
Cerner
EMAR
ISCHTR
Pulse Check
Salar
Avatar
Oaxaca
Other
None
5B.

If you selected "Other" in question 5A, please specify below. If you did not select "Other", please write "N/A".

6.

Which of the following valid American Heart Association Cardiopulmonary Resuscitation (CPR) certificates do you possess?

As a reminder, all certifications must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the "Professional Licenses, Certifications or Registrations" section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update the appropriate section before submitting your application.

Basic Life Support (BLS) for Healthcare Providers
Advanced Cardiovascular Life Supported (ACLS)
Pediatric Advanced Life Support (PALS)
None of the above
7.

How much verifiable full-time equivalent work experience do you have as a health care provider serving a diverse urban population? (Full-time experience is equivalent to 40 hours per week.)

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

I have NO verifiable experience.
I have some verifiable experience, but less than 1 year (<1,999 hours) of verifiable experience.
At least 1 year but less than 2 years (2,000 to 3,999 hours) of verifiable experience.
2 years or more (4,000 hours or more) of verifiable experience.
8.

How much verifiable full-time equivalent work experience do you have providing chronic disease care management? (Full-time experience is equivalent to 40 hours per week.)

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

I have NO verifiable experience.
I have some verifiable experience, but less than 1 year (<1,999 hours) of verifiable experience.
At least 1 year but less than 2 years (2,000 to 3,999 hours) of verifiable experience.
At least 2 years but less than 3 years (4,000 to 5,999 hours) of verifiable experience.
3 years or more (6,000 hours or more) of verifiable experience.
9A.

Which of the following certifications do you possess?

As a reminder, all certifications must be listed in the application in order to be considered in review of Minimum Qualifications.  If you do not include the license you are about to describe in the "Professional Licenses, Certifications or Registrations" section of your application, you will not receive credit for this experience.  If you are copying an old application, please take the time to update the appropriate section before submitting your application.

Certification in Ambulatory Care Nursing.
Certified Occupational Health Nurse (COHN).
Certified Occupational Health Nurse-Specialist (COHN-S).
Certification Board of Infection Control and Epidemiology (CBIC).
Community Health Nursing: RN-BC.
CA Public Health Nurse (PHN).
Other.
None of the above.
9B.

If you selected "Other" in question 9A, please specify below. If you did not select "Other", please write "N/A".

10.

Are you bilingual in Cantonese?

Yes No
 

CERTIFICATION: I hereby certify that I am the author of this application and that all information is true and is based on my background, skills and experiences.  I understand that I must provide verification documentation of the qualifying training and experience that I indicated above.  I understand that any false or incorrect statement may result in my disqualification or dismissal from employment with the City and County of San Francisco. I understand and agree that any information provided is subject to verification.