The purpose of this Supplemental Questionnaire is:
To let us know your top 5 work location choices in rank order. No location should be used more than once; AND
To assist in determining if you meet the specified minimum qualifications of class 2903 Hospital Eligibility Worker. All applicants are required to complete the supplemental questionnaire as part of the online application 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/information are subject to VERIFICATION.
Do you have experience working in the public sector such as a city or county department?
Yes
No
Are you a current City and County of San Francisco (CCSF) employee?
Yes
No
Do you have experience working in public health in a public sector?
Yes
No
Are you a current San Francisco Department of Public Health employee?
Yes
No
PLEASE CAREFULLY REVIEW THE LOCATIONS AND ANSWER THE FOLLOWING QUESTIONS.
Positions may be located in the following locations:
Work Location
Address
1M- General Medicine Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
1N – Oral Surgery
ZSFG Campus , 1001 Potrero Ave., SF, CA
3D – Gastroenterology Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
3M –Surgical Specialties Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
4C – Burn /Wound Clinic & Infusion Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
4J – Cardiology Lab
ZSFG Campus , 1001 Potrero Ave., SF, CA
4M – Surgical Specialties Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
5M – Women’s Health Center
ZSFG Campus , 1001 Potrero Ave., SF, CA
6G – Women’s Options Center
ZSFG Campus , 1001 Potrero Ave., SF, CA
6M – Children’s Health Center
ZSFG Campus , 1001 Potrero Ave., SF, CA
Call Center located at LHH
LHH Campus, 375 Laguna Honda Blvd, SF, CA
Castro-Mission Health Center
3850 17th St, SF, CA
Child Pediatrics - 6M
ZSFG Campus , 1001 Potrero Ave., SF, CA
Chinatown Public Health Center
1490 Mason St, SF, CA
Community Health Programs for Youth
ZSFG Campus , 1001 Potrero Ave., SF, CA
Curry Senior Center
333 Turk St, SF, CA
Family Health Center
ZSFG Campus , 1001 Potrero Ave., SF, CA
Float Pool
Rotate DPH Locations
Health at Home
ZSFG Campus , 1001 Potrero Ave., SF, CA
Imaging (Radiology)
ZSFG Campus , 1001 Potrero Ave., SF, CA
Maxine Hall Health Center
1301 Pierce St, SF, CA
Medical Respite & Sobering Center
1171 Mission St, SF, CA
Ocean Park Health Center
24th Ave, SF, CA
Outpatient Dialysis
ZSFG Campus , 1001 Potrero Ave., SF, CA
Positive Health Program – Ward 86
ZSFG Campus , 1001 Potrero Ave., SF, CA
Potrero Hill Health Center
1050 Wisconsin St, SF, CA
Rehabilitation Clinic Acute Care
ZSFG Campus , 1001 Potrero Ave., SF, CA
Rehabilitation Clinic- Long Term Care
LHH Campus, 375 Laguna Honda Blvd, SF, CA
Richard Fine Peoples’ Clinic (Outpatient)
ZSFG Campus , 1001 Potrero Ave., SF, CA
Silver Avenue Family Health Center
1525 Silver Ave, SF, CA
Southeast Health Center
2401 Keith St, SF, CA
Tom Waddell Health Center Urgent Care
50 Ivy St, SF, CA
Tom Waddell Urban Health Clinic
230 Golden Gate Ave, SF, CA
Tuberculosis (TB) Clinic
ZSFG Campus , 1001 Potrero Ave., SF, CA
Ward 81 – Urgent Care
ZSFG Campus , 1001 Potrero Ave., SF, CA
Ward 86 – Hematology / Oncology
ZSFG Campus , 1001 Potrero Ave., SF, CA
Ward 92 – Medical Specialties (Dermatology )
ZSFG Campus , 1001 Potrero Ave., SF, CA
Every effort will be made to honor one of your top 5 choices; however, placement is not guaranteed and will be based on operational needs.
1ST CHOICE
Of the work locations listed above, which location would be your first choice to work at?
Type your FIRST CHOICE in the box below.
2ND CHOICE
Of the work locations listed above, which of the locations would be your second choice to work at?
Type your SECOND CHOICEin the box below. Do not repeat your answers.
3RD CHOICE
Of the work locations listed above, which location would be your third choice to work at?
Type your THIRD CHOICE in the box below. Do not repeat your answers.
4TH CHOICE
Of the above work locations, which location would be your fourth choice to work at?
Type your FOURTH CHOICE in the box below. Do not repeat your answers.
5TH CHOICE
Of the above work locations, which location would be your fifth choice to work at?
Type your FIFTH CHOICE in the box below. Do not repeat your answers.
MINIMUM QUALIFICATIONS: This section is designed to assist in determining if you meet the specified minimum qualifications of class 2903 Hospital Eligibility Worker. 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/information are subject to verification. Please note, verification is required at time of filing. Please refer to the "How to Apply" section on the job announcement.
1.
Based on your education, indicate the selection that best matches your HIGHEST educational attainment (DO NOT COUNT UNITS THAT ARE IN PROGRESS)
High School diploma or equivalent (GED or High School Proficiency Examination)
Some college and possess 1-14 semester units/1-21 quarter units of coursework from an accredited college or university
Some college and possess 15-29 semester units/22-44 quarter units of coursework from an accredited college or universty
Some college, successful completion of 30-59 semester units/45-89 quarter units from an accredited college or university
Some college, successful completion of 60-89 semester units/90-134 quarter units from an accredited college or university
Some college, successful completion of 90+ semester units/135+ quarter units from an accredited college or university
Completion of a Bachelor's Degree from an accredited college or university
Completion of a Master's Degree from an accredited college or university
Completion of a Ph.D. from an accredited college or university
None of the Above
2.
How much verifiable direct public contact clerical work experience do you possess?
Note: 2,000 hours of experience = 1 year of experience
I do not have verifiable direct public contact clerical work experience
I have verifiable clerical work experience but not direct public contact experience
I have 6 months or less of verifiable direct public contact clerical work experience
I have at least 6 months but less than 1 year (2,000 hours) of verifiable direct public contact clerical work experience
I have at least 1 year (2,000 hours) but less than 2 years (4,000 hours) of verifiable direct public contact clerical work experience
I have at least 2 years (4,000 hours) but less than 3 years (6,000 hours) of verifiable direct public contact clerical work experience
I have 3 years or more (6,000+ hours) of verifiable direct public contact clerical work experience
3.
For the experience you indicated in question 2, select the direct public contact clerical work duties you have performed. Check ALL that apply to you.
Use of computer applications to input, retrieve, and analyze information
Working with a diverse client population
Performing responsibilities involving interviewing to acquire detailed personal or confidential information
Interpreting and applying rules, regulations, and policies
Creating and processing documents related to financial or personal histories of clients
Assisting clients with the completion of forms or correspondence
I have not performed any of these direct public contact clerical work duties
4.
Indicate the total amount of verifiable experience you have determining eligibility for health and/or social services programs, loans, financial assistance, unemployment, or veterans benefits.?
Note: 2,000 hours of experience = 1 year of experience
I do not have verifiable experience determining eligibility
I have some verifiable experience determining eligibility, but less than 6 months
I have at least 6 months but less than 1 year (2,000 hours) of verifiable experience determining eligibility
I have at least 1 year ( 2,000 hours) but less than 2 years (4,000 hours) of verifiable experience determining eligibility
I have 2 years or more (4,000 hours or more) of verifiable experience in determining eligibility
By checking this box, I certify that I understand verification is required at the time I submit my application. I understand that I am to upload my verification document and some of the ways I can verify are: transcripts, performance appraisals, verification letter. More information is located in the "How to Apply" section of my application.
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