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Supplemental Questionnaire

Last Name
First Name
 

CITY AND COUNTY OF SAN FRANCISCO

2469 DIAGNOSTIC IMAGING TECHNOLOGIST III

SUPPLEMENTAL QUESTIONNAIRE

The purpose of this Supplemental Questionnaire is to obtain information regarding your education, experience and/or training in relation to this classification. This Supplemental Questionnaire must be completed and submitted online with the application. Responses cannot be changed or edited after submission. Failure to provide complete responses to this Supplemental Questionnaire may result in rejection of the application.

This Supplemental Questionnaire consists of two sections. The first section will be used as a tool to screen applications for minimum qualification requirements. The second will be used to measure your knowledge, skills and/or abilities in job-related areas.

By selecting "yes" below, you confirm that you understand that your qualifying education, experience and/or training MUST be included in the body of your application and in this Supplemental Questionnaire.

Yes No

 

INSTRUCTIONS: The purpose of the Minimum Qualifications section of the 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 in this section of the Supplemental Questionnaire are mandatory for participation in this recruitment process.

Select the options that most closely describe the certifications that you possess. Please note, if the education/certifications listed on your application do not support the selections that you make on these questions, your application will be rejected. Be sure to include all relevant certifications and education on your application. A resume will not substitute for a completed application. If you write “see resume” on the application or Supplemental Questionnaire, your application will be rejected.


 

Minimum Qualification #1

I currently possess a valid certificate issued by the State of California as a Certified Radiologic Technologist (CRT).
I do not currently possess a valid certificate issued by the State of California as a Certified Radiologic Technologist (CRT).
 

Minimum Qualification #2

I possess certification in, and current registration with, the American Registry of Radiologic Technologists (AART).
I do not presently have certification in and/or do not have current registration with, the American Registry of Radiologic Technologist (AART).
 

Minimum Qualification #3

Please check all that apply. I possess certification in the following advanced modalities:

Mammography (MM)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Quality Management (QM)
Cardiac-Interventional (CI)
Vascular-Interventional (VI)
I do not currently possess certification in any of the above listed advanced modalities.
 

Minimum Qualification #4

I possess a valid permit in Fluoroscopy equipment issued by California Department of Public Health.
I do not currently possess a valid permit in Fluoroscopy equipment issued by California Department of Public Health.
 

Minimum Qualification #5

I possess certification in Cardio-pulmonary Resuscitation (CPR).
I do not currently possess certification in Cardio-pulmonary Resuscitation (CPR).
 

I understand that I must provide a copy of my certifications demonstrating that I possess the above stated certifications, if requested.


 

Select the option that most closely describes your experience working as a Diagnostic Imaging Technologist.


 

Minimum Qualification #6

I have 36 months or more of experience working as a Diagnostic Imaging Technologist.
I have 24 - 35 months of experience working as a Diagnostic Imaging technologist.
I have 12 - 23 months of experience working as a Diagnostic Imaging technologist.
I have 1 - 11 months of experience working as a Diagnostic Imaging Technologist.
I have no experience working as a Diagnostic Imaging Technologist.
 

I understand that I must provide verification documentation of the qualifying experience that I indicated above, if requested.


 

 


INSTRUCTIONS: The purpose of this portion of the Supplemental Questionnaire is to determine your knowledge, skills and abilities in job-related areas that have been identified as critical for satisfactory performance in this classification. The information provided here must be consistent with the information on your application and is subject to verification.  Please note, if the experience listed on your application does not support the selections that you make on these questions, your application may be rejected. Be sure to include all relevant experience in the work history sections of the application. A resume will not substitute for a completed application. If you write “see resume” on the application, your application will be rejected.

For each of the following statements select the corresponding amount of fulltime firsthand experience you have performing the stated task(s). If you performed the stated task(s) as a part-time employee, please note that 1,000 hours of qualifying experience is equivalent to 6 months of fulltime experience. Additionally, experience gained in a classroom and/or as a trainee on-the-job does not constitute firsthand experience. Please also provide the information requested in the text box following each statement.


1

Functioning as a lead worker in an assigned area or for a shift, including managing workload relative to available resources and prioritizing work and assigning tasks to Diagnostic Imaging Technologists and support staff.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

2

Acting as preceptor to new staff, or to an employee learning new skills or equipment. This includes training, orienting and documenting initial and annual competencies of staff and assisting others with technical or positioning advice.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

3

Performing general diagnostic procedures, using fixed or portable, general, digital, fluoroscopic or other diagnostic equipment.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

4

Supervising and overseeing a shift or assigned area of technical and support personnel.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

5

Performing diagnostic imaging procedures in one of the following advanced modalities: Mammography (MM), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Quality Management (QM), Cardiac-Interventional (CI) Radiography, and/or Vascular-Interventional (VI).

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

Based on your response above, which advanced modality did you perform diagnostic imaging procedures in?

Mammography (MM)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Quality Management (QM)
Cardiac-Interventional (CI) Radiography
Vascular-Interventional (VI)
I do not have experience performing diagnostic imaging procedures in any of the advanced modalities listed above.
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

6

Assessing general patient condition, including stability, pain, safety and, as necessary, taking action consistent with standards.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

7

Documenting procedures and events in patient’s medical records and departmental logs, in accordance with regulatory, hospital and departmental standards. This also included identifying images and documents with the patient.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

8

Applying principles of radiation safety in compliance with federal, state, and departmental logs, in accordance with regulatory, hospital and departmental standards; This includes using appropriate filters, cones, protective clothing and devices to obtain high-quality images with radiation exposure levels as low as reasonably achievable to patients, others and self and wearing and exchanging radiation monitoring devices.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

9

Assisting physicians in preparing and/or administering contrast media.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

10

Transporting patients using gurneys, wheelchairs and beds. This included transferring patients to and from the exam table.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

11

Scheduled patients and procedures, this included transferring paper orders into an electronic order entry system, processing paperwork and assisting patients and other customers.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

12

Assisted in training and evaluation of imaging technologist students, interns and/or staff.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

13

Participated in quality control and assurance procedures, including quality improvement projects.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

14

Maintained patient medical records and data integrity using radiology IT systems.

36 months or more of fulltime firsthand experience as described
18 - 35 months of fulltime firsthand experience as described
1 - 17 months of fulltime firsthand experience as described
I do not have any fulltime firsthand experience as described
 

List the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you did not perform this function please type N/A in the box below.)

15

Do you have experience working in a trauma center?

Yes No
 

If you indicated yes, that you have experience working in a trauma center, what trauma level was the hospital that you worked in? (if you worked in multiple trauma centers, please select the highest level of the hospitals that you worked in).

Level 1
Level 2
Level 3
I do not have experience working in a trauma center
16

Do you have firsthand experience utilizing any of the following equipment/ techniques (check all that apply)?

Computed Radiography (CR)
Digital Radiography (DR)
Fluoroscopy in an OR
I do not have any firsthand experience utilizing any of the listed techniques
17

Have you been involved in a process improvement strategy to streamline an organizational process? (Such as implementing Lean Management for a hospital).

Yes No
 

If you indicated yes, that you have been involved in a process improvement strategy, please describe the process that was utilized and your role in the project.

Also include the name of your Employer/Agency, your Supervisor, and his or her contact information along with the dates of employment where you gained the experience indicated above.

Please also list your Position or Job Title at the time the task was performed and the number of months/years you performed the task.

(If you indicated no, that you have been involved in a process improvement strategy, type “N/A” in the box below.)

 

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 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.