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#0123-RS7090-AC
Supplemental Questionnaire

Last Name
First Name
 

PATTERN I:

Education:  Did you graduate from an accredited four year college or university with major coursework in social, behavioral or health sciences; public or business administration, or a related field?  If yes, please indicate name of accredited four year college or university where you completed your degree, date and degree received.

 

PATTERN II:

Education:  If you did not graduate from an accredited four year college or university in Pattern I, did you complete 60 semester units at an accredited college or university with major coursework in psychology, sociology, counseling, business administration, public administration, education or a related field?  If yes, please list the courses and units completed.

 

Experience:  Describe your one year of responsible work directly performing/providing social services, public education/outreach, public assistance eligibility, vocational guidance, or similar services.  Please include the name of employer, dates of employment, and the specific duties performed.

 

SUBSTITUTION:  Additional qualifying experience may substitute for the education on a year-for-year basis. 

Please describe your years of experience working directly performing/providing social services, public education/outreach, public assistance eligibility, vocational guidance, or similar services. Include in your response: name of employer, dates of employment and specific duties performed.

 

AND:

License:  Possession of a valid California Driver's License.  Please list your license number and the date of expiration.