Official SealSan Joaquin County Human Resources Division


#1220-RS3403-01
Supplemental Questionnaire

Last Name
First Name

1)

Experience: (Check All that Apply)


 

Social Worker III:

I possess a minimum of TWO (2) YEARS of experience as a SOCIAL WORKER II in San Joaquin County
I possess THREE (3) YEARS paid POST BACHELOR'S social casework experience at a level comparable to a SOCIAL WORKER in San Joaquin County.
I do not possess any experience noted above.
 

Social Worker IV:

I possess ONE (1) YEAR of experience as a SOCIAL WORKER III in San Joaquin County
I possess FOUR (4) YEARS of PAID FULL TIME social casework experience with adults, children, or families in a social services or health care setting, including TWO YEARS IN A PROTECTIVE SOCIAL SERVICES SETTING.
I do not possess any experience listed above
 

Social Worker V:

I possess ONE (1) YEAR of paid post-master's degree social casework experience equivalent to the class of SOCIAL WORKER IV in San Joaquin County.
I possess ONE (1) YEAR of full time, paid post-master's social casework experience.
I do not possess any experience listed above.
2)

Describe in detail your paid social casework experience with adults, children or families in a social services or health care setting.

3)

Describe your paid social casework experience in a protective social services setting.

4)

Education: (Check All That Apply)

A. I have graduated from an accredited four-year college or university, preferably with a major in social work, sociology, psychology, counseling or a closely related field.
B. I have the ability to obtain 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.
C. I have the ability to obtain 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.
D. 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.
E. 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 do not possess any of the education noted above.
5)

Please provide the expected month and year of graduation if:

1. You have the ability to obtain 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. OR

2. You have the ability to obtain 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.

If it does not apply to you, type N/A.

6)

Do you possess a Marriage and Family Therapy (M.F.T.) internship number?

Note: Number will be source verified by Human Resources with the State of California

Yes No
 

If Yes, Please provide your Internship Number. If No, type "N/A":

7)

Do you possess possess a State of California Marriage and Family Therapy (M.F.T.) License?

Note: Must be current and will be source verified by Human Resources with the State of California

Yes No
 

If yes, provide your M.F.T. License number. If No, type "N/A":

 

Do you have a valid California Driver's License? Note: All Social Worker positions require a valid California Driver’s License.

Yes No
 

Provide the number and expiration date of your license below:

 

This recruitment will be used to fill positions with Child Protective Services (CPS) and Adult Protective Services (APS). Please indicate your interest in referral below:

I would like to be referred for interviews in both CPS and APS.
I am only interested in being referred for interviews in CPS.
I am only interested in being referred for interviews in APS.