Official SealSan Joaquin County Human Resources Division


#0818-RS3405-01
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess any of the following? (Check all that apply):

I possess a master's degree in social work from a recognized school of social work based on a two-year program that included supervised field placement.
I possess a master's degree from an accredited college or university in counseling with a specialization in Marriage and Family Therapy (M.F.T.) based on a two-year program with coursework sufficient to meet State standards for an M.F.T. license which included supervised field placement as part of the course.
I possess an M.F.T. Internship number.
I possess a valid M.F.T. license issued by the State of California.
I do not possess any of the items noted above.

2.

If you possess any of the items noted in question 1, please complete the applicable box(es) below. If not applicable, please note N/A:


A.

Master's Degree in Social Work - please note the college or university attended:

B.

Master's Degree from an accredited college or university in counseling with a specialization in Marriage & Family Therapy (M.F.T.) that included coursework sufficient to meet State standards for an M.F.T. license. You must possess an M.F.T. Internship number to validate the coursework received. Provide your M.F.T. Internship number (NOTE: the M.F.T. Internship number does not need to be current):

C.

Provide your M.F.T. license number:

D.

This position also requires a valid California's driver's license. Please note the number and expiration date below:

3.

This is an advanced journey-level Social Worker position. The Social Worker V is expected to perform at the highest level of independent judgement and authority. The position requires at least one (1) year of paid post-master's social casework experience.

Using the space below, describe in detail your paid post-master's social casework experience. Include in your answer the population you served, what social casework services you provided, your role in home visits, court hearings, evaluations and assessments, case records and reports. (Note: Employer information should be clearly noted on the employment section of your application)