Official SealSan Joaquin County Human Resources Division


#1022-RS3041-PC
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a Master's Degree in Social Work (MSW) from an accredited institution?

If yes, ensure that you identify the institution in the Education portion of the application.
Yes No
2.

Do you possess a valid California driver's license?
Yes No
 

If you responded yes, list your driver's license number and expiration date below:

3.

SPECIAL REQUIREMENTS

(1) Must be elgible for waiver of licensing requirements for a Licensed Clinical Social Worker (LCSW) set by the State of California Welfare and Insitutions Code, Section 5600.2.  Generally, LCSW candidates have three years to obtain their license, commencing with the date of employment in a job that requires licensure.  Out of state candidates who are eligible for licensure have two consecutive opportunities to pass the California exam before they are no longer within the waiver period.

(2) Must be registered or eligible for registration with the California Board of Behavioral Science Examiners for the purpose of accumulating supervised horus toward qualification for licensure and must notify the Board within 30 days of employment of their intent to gain such experience.
 

By checking this box, I acknowledge that I have read and understood the special requirements listed above.