Supplemental Questionnaire

	Human Resources Department

	#18-443170-B1
	Supplemental Questionnaire


Last Name	First Name

This Supplemental Questionnaire will be used to determine applicants’ qualifications for this position and assess an applicant’s ability to advance in the recruitment process; therefore, applicants are encouraged to answer all questions thoroughly and completely. Omitted information will not be considered or assumed. Applicants who have no experience in a specific area are recommended to state "no experience in this area" instead of leaving the space blank.

Please note that the experience in your answers must be reflected in your employment history.

Do you possess six (6) months experience performing public assistance benefit eligibility determination in a California County Department of Social Services?

Yes No

Is your experience performing public assistance benefit eligibility determination within the last two (2) years?

Yes No

This position requires Spanish skills. Applicants will be required to demonstrate proficiency in speaking, reading, and writing in Spanish. Are you proficient in speaking, reading, and writing in Spanish?

Yes No