Official SealDepartment of Human Resources

Supplemental Questionnaire

Last Name
First Name


2574 Clinical Psychologist

Human Services Agency

The purpose of this Supplemental Questionnaire is to determine whether you meet the required licensure and to determine your qualifications in job-related areas of the 2574 Clinical Psychologist position.

The information provided should be consistent with the information on your application and is subject to verification. Verification of work experience and licensure may be collected at any time during or after the selection process.


By checking the following box, I acknowledge that I have read, understand, and agree to the above listed information regarding the supplemental questionnaire instructions.


Do you possess a valid license as a Psychologist issued by the California Board of Psychology as defined in Chapter 6.6 of the Business and Professions Code, Psychology Licensing Law, Sections 2900-2903, 2914?

Yes No

I am proficient in reading, writing and speaking Cantonese and understand that I must pass the language test before moving forward in the hiring process.


Yes No

I hereby certify that I am the author of this Supplemental Questionnaire and that all information presented is true and it is based on my background, skills and experience.  I understand that false, incomplete, or incorrect information may result in my disqualification or dismissal from employment with the City and County of San Francisco.  I also understand and agree that any information provided is subject to verification.