Official SealSan Joaquin County Human Resources Division


#0922-RS3410-AC
Supplemental Questionnaire

Last Name
First Name
1.

PATTERN I

Do you have two years of experience as a Social Worker II in San Joaquin County?

Yes No
 

If you answered "yes" to Question 1, list your Employee Identification Number below, then proceed to Question 4.

2.

PATTERN II

EDUCATION

Did you graduate from an accredited four-year college or university, preferably with a major in social work, sociology, psychology, counseling, or a closely related field?

Yes No
 

Indicate the type of degree completed, major, and the name of the school:

3.

PATTERN II

EXPERIENCE

Describe in detail at least three (3) years of paid, full-time social casework, including two (2) years at the journey level, including employer name, job title, dates of employment, and hours worked per week:

4.

Do you possess a valid California driver's license?

Yes No
 

If you answered "yes", please indicate drivers license number and expiration date:

5.

Employees at Mary Graham Children’s Shelter are subject to the authority, rules, regulations, standards, and approval of the Community Care Licensing Authority (CCL) of the California Department of Social Services.  In addition to the minimum qualifications, as a condition of employment, approval of the CCL is required for both initial appointment and for continued employment at Mary Graham Children's Shelter.

Do you acknowledge and accept these terms and conditions of employment?

 

Yes No