Official SealSan Joaquin County Human Resources Division


#0419-RS1023-01
Supplemental Questionnaire

Last Name
First Name
1.

For both qualifying Pattern I and Pattern II, possession of a current certificate as an Alcohol and Other Drug (AOD) Counselor issued by a certifying agency approved by the State of California is required.

Do you possess this certificate?

Yes No

 

If you answered "yes" to question 1, attach a copy of your certificate to your application or email it to: humanresources@sjgov.org by the final filing date. Please list the job number and job title in the subject line.


 

If you answered "no" to question 1 and do not possess certification as an AOD Counselor, possession of a license to practice medicine issued by the Medical Board of California, or Psychologist licensed by the Board of Psychology, or Clinical Social Worker or Marriage and Family Therapist licensed by the California Board of Behavioral Sciences, or an Intern registered with the California Board of Psychology or the California Board of Behavioral Sciences may substitute. 

If you are using this substitution, list your type of license/certification:

 

Possession of a valid California driver's license may be required by nature of assignment.  Do you possess a valid California driver's license?

Yes No
2.

PATTERN I - Education

Did you complete a certificate program in substance abuse counseling, recognized by the San Joaquin County Department of Health Care Services?

Yes No
 

If you answered "yes" to question 2, provide the type of certification and the school attended.  A copy of the certificate must be submitted with the application.

 

PATTERN I - Experience

Describe at least four years of paid counseling or case management experience in a substance abuse or social crisis program at a level equivalent to Substance Abuse Counselor II in San Joaquin County service.  Include employer name, dates of employment, job title, hours worked per week, and the specific counseling or case management duties performed:

3.

PATTERN II - Education

Did you graduate from an accredited college or university with a major in psychology, social work, business or public administration or closely related field?

Yes No
 

If you answered "yes" to question 3, list the type of degree completed, your major and the school attended:

 

PATTERN II - Experience

Descirbe at least one year of paid counseling or case management experience in a substance abuse or social crisis program at a level equivalent to Substance Abuse Counselor II in San Joaquin County service.  Include the employer name, dates of employment, job title, hours worked per week, and the specific counseling or case management duties performed: