The purpose of this Supplemental Questionnaire is to assist in determining if you meet the specified minimum qualifications of class 2908 Senior Hospital Eligibility Worker. All applicants are required to complete the supplemental questionnaire as part of the online process. The information you provide must be consistent with the information listed on your online application. The supplemental questionnaire does not substitute for the online application. All statements are subject to verification.
1.
How many years of verifiable experience performing the duties of an ELIGIBILITY WORKER in a Hospitaldo you possess? (2000 hours = 1 year)
I do not have verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have less than 6 months of verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have 3 or more years (6,000 + hours) of verifiable experience performing the duties of an Eligibility Worker in a Hospital
I have experience working in a Hospital, but NOT performing the duties of an Eligibility Worker
2.
How many years of verifiable experience do you have performing the duties of an ELIGIBILITY WORKER in a Community-Based Health Organization do you possess? (2000 hours = 1 year)
I do not have verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have less than 6 months of verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have 3 or more years (6,000 + hours) of verifiable experience performing the duties of an Eligibility Worker in a Community-Based Health organization
I have experience working in a Community-Based Health organization, but NOT performing the duties of an Eligibility Worker
3.
How many years of verifiable experience performing the duties of an ELIGIBILITY WORKERin a Medi-Cal Unit do you possess? (2000 hours = 1 year)
I do not have verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have less than 6 months )of verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have at least 1 year (2,000 hours) but less than 2 years (6,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have at least 2 years (6,000 hours) but less than 3 years (6,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have 3 or more years (6,000 + hours) of verifiable experience performing the duties of an Eligibility Worker in a Medi-Cal unit
I have experience working in a Medi-Cal unit, but NOT performing the duties of an Eligibility Worker
4.
How many years of verifiable experience do you have performing the duties of an ELIGIBILITY WORKER in a MEDICAL CLINIC? (2000 hours = 1 year)
I do not have verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have less than 6 months of verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have 3 or more years (6,000 + hours) of verifiable experience performing the duties of an Eligibility Worker in a Medical Clinic
I have experience working in a Medical Clinic, but NOT performing the duties of an ELIGIBILITY WORKER
5.
How many years of verifiable experience do you have determining eligibility for various Federal, State and County programs that reimburse for for MEDICAL CARE? (2000 hours = 1 year)
I do not have verifiable experience determining eligiblity for various Federal, State and county programs
I have experience determining eligibility for Federal, State, and county programs but NOT for programs that reimburse for MEDICAL CARE
I have less than 6 months of verifiable experience determining eligiblity for various Federal, State, and county programs that reimburse for MEDICAL CARE
I have at least 6 months but less than 1 year (2,000 hours) of determining eligiblity for various Federal, State, and county programs that reimburse for MEDICAL CARE
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable experience determining eligiblity for various Federal, State, and county programs that reimburse for MEDICAL CARE
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable experience determining eligiblity for various Federal, State, and county programs that reimburse for MEDICAL CARE
I have more than 3 years (6,000 + hours) of verifiable experience determining eligiblity for various Federal, State, and county programs that reimburse for MEDICAL CARE
6.
Do you possess a Certified Enrollment Counselor Certification for Covered California?
Yes
No
CERTIFICATION:By checking this box, I hereby certify that I am the author of the information supplied in this supplemental questionnaire. I understand that any false or incorrect statements may result in my disqualification or dismissal from employment with the San Francisco Department of Public Health and City and County of San Francisco. I also understand and agree that the information provided is subject to verification.
Department of Human Resources