Official SealSan Joaquin County Human Resources Division


#1024-RS2012-AC
Supplemental Questionnaire

Last Name
First Name
 

Are you currently licensed as a Licensed Clinical Social Worker (LCSW) in the State of California?
Yes No
 

License Number AND Expiration Date
 

Do you possess a Master's or Doctorate degree in one of the following?

  • Social Work
  • Counseling
  • Psychology
  • Other Major Acceptable for LCSW
Yes No

 

Please ensure this is CLEARLY indicated in the Education section of your application.
 

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

License Number AND Expiration Date