Department of Human Resources

2586 Health Worker II

The purpose of this supplemental questionnaire is to determine if you meet the minimum qualifications of the position.  The information youprovide to the following questions does not substitute for the online application. You must still complete all sections of the application.  All information provided MUST also be consistent with the information listed on your application. 

All information provided is subject to verification.  Please do not write, "See Application" or "See Resume" as a response. 

Please indicate the total amount of experience you have performing a combination of at least two (2) of the following duties WITHIN THE LAST FIVE (5) YEARS. (Note: One year is equivalent to 2,000 hours)

• 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.

Please provide the following information about the work experience you indicated above.   Note: Information provided must be consistent with the information listed on your online application.

1. Name of employer where you obtained the experience
2. Dates of employment (e.g. MM/YYYY-MM/YYYY)
3. Name of supervisor who can verify

If you do not have any experience, please type N/A.   

For the experience you indicated above, please select the work duties you have performed within the last five (5) years. 

Do you possess a Community Health Worker certificate from City College of San Francisco?

Please indicate the total amount of verifiable experience you have working as an interpreter in a medical care setting. 

Please provide the following information about the work experience you indicated above.   Note: Information provided must be consistent with the information listed on your online application.

1. Name of employer where you obtained the experience
2. Dates of employment (e.g. MM/YYYY-MM/YYYY)
3. Name of supervisor who can verify

If you do not have any experience, please type N/A.   

Do you possess a certificate from a Medical Interpreter educational program of at least 10 months (equivalent to 350 hours) of classroom and internship work that is administered by an accredited educational institution?  Note: Coursework in progress is not qualifying. Medical interpreter educational programs include, but not limited to the following:

• Spanish Medical Interpreter Certificate Program, Berkeley City College, Berkeley, CA;

• Healthcare Interpreter Certificate Program, City College of San Francisco, San Francisco, CA;

• Healthcare Interpreter Program, Cornerstone International College, Union City, CA;

• Healthcare Interpreting Certificate, CSU- Fullerton, Extended Education;

• Health Care Interpreter Program, Mount San Antonio College, Walnut, CA;

• Medical Interpreter Program, Reedley College Reedley, CA; 

• Medical Interpreting Certificate Program, CSU-Los Angeles

Please specify the name of the accredited educational institution you obtained your Medical Interpreter Certificate.  Please be sure to also indicate the name of the medical interpreter program and the location. 

If this does not apply to you, please type NA.

Depending on the department's needs, positions will require proficiency in a specific target language other than English.  Please indicate the language(s) you are proficient in. Check all that apply:

If you responded, "Other," please specify the foreign language in the box below.