Official SealSan Joaquin County Human Resources Division


#0119-RS3401-01
Supplemental Questionnaire

Last Name
First Name
1.

Have you graduated 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
 

If yes, provide the following:

  • School Name
  • Major
2.

In order to qualify, you must possess a valid California driver's license.  Please provide your license number and expiration date (mm/dd/yy).


3.

If you are bilingual, please indicate the language(s) in which your are proficient.  Check all boxes that apply.  You will be given a bilingual proficiency exam prior to being referred. 


 

No language other than English.

 

Cambodian

 

Hmong

 

Laotian

 

Spanish

 

Vietnamese

 

Other

 

If you checked, "Other", please indicate the language(s) in which you are proficient.


4.

If you indicated you are proficient in a language in question #3, please indicate if you can speak, read, and/or write. Check all boxes that apply.


 

Read

 

Speak

 

Write

5.

If you indicated you are proficient in a language in question #3, have you passed a bilingual proficiency exam administered by San Joaquin County?

Yes No