Department of Human Resources

#PBT-0941-092490
Supplemental Questionnaire

Last Name
First Name

0941 MANAGER VI - DIRECTOR OF DENTAL SERVICES (PBT-0941-092490)

MINIMUM QUALIFICATION SUPPLEMENTAL QUESTIONNAIRE

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY

The purpose of this Supplemental Questionnaire is to assist with evaluating possession of the required Minimum Qualifications(i.e. required license and experience) for the 0941 Manager VI - Director of Dental Services position.

IMPORTANT NOTE: Attaching a resume does not substitute for submitting a completed application. Your application’s Education, Professional Licenses, Certifications, or Registrations, and Employment Record sections should clearly demonstrate how you satisfy this position’s Minimum Qualifications. Do NOT type “see resume” or leave the above-mentioned application sections blank.

It is suggested that you allow ample time to submit your application and Supplemental Questionnaire responses before the filing deadline. If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with and supported by the information on your application (i.e. Professional Licenses, Certifications, or Registrations & Employment Record sections) and are subject to verification at any time.

As a reminder, all qualifying licensure, registration, certification, and experience must be listed in the application in order to be considered in review of Minimum Qualifications. If you do not include the licensure, registration, certification, and experience you are about to describe in the applicable sections of your application, you will not receive credit. If you are copying an old application, please take the time to update applicable sections before submitting your application.

1.

Do you have a valid license to practice dentistry issued by the Dental Board of California?

Yes No

2.

Do you have a valid license to practice dentistry issued by another state within the United States of America?

Yes No

3.

How much full-time experience do you have managing a health care entity?

One (1) year of full-time experience is equivalent to 2,000 hours.

I have some, but less than one (1) year of this experience

I have at least one (1) year, but less than two (2) years of this experience

I have at least two (2) years, but less than three (3) years of this experience

I have at least three (3) years, but less than four (4) years of this experience

I have at least four (4) years, but less than five (5) years of this experience

I have five (5) years of this experience or more

I don't have any of this experience

4.

How much of your full-time experience managing a health care entity, referenced in #3 above, included supervising professionals?

One (1) year of full-time experience is equivalent to 2,000 hours.

I have some, but less than one (1) year of this experience

I have at least one (1) year, but less than two (2) years of this experience

I have at least two (2) years, but less than three (3) years of this experience

I have at least three (3) years, but less than four (4) years of this experience

I have at least four (4) years, but less than five (5) years of this experience

I have five (5) years of this experience or more

I don't have any of this experience

5.

How much full-time experience do you have practicing dentistry?

One (1) year of full-time experience is equivalent to 2,000 hours.

I have some, but less than one (1) year of this experience

I have at least one (1) year, but less than two (2) years of this experience

I have at least two (2) years, but less than three (3) years of this experience

I have at least three (3) years, but less than four (4) years of this experience

I have at least four (4) years, but less than five (5) years of this experience

I have five (5) years of this experience or more

I don't have any of this experience

6.

CONDITIONS OF EMPLOYMENT: I understand that if my valid license to practice dentistry is issued by another state, within the United States of America, I can participate in this examination process and if successful, be placed on the resulting eligible list/score report. However, if selected, I will not be appointed/hired until I obtain a valid license to practice dentistry issued by the Dental Board of California and it must remain valid throughout the duration of employment.

CERTIFICATION: I understand that checking this box will serve as my electronic signature. I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience. I understand and agree that any information provided is subject to verification. I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.