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Human Resources Department
#19-333180-B2


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.


1

Mental Health Clinicians may be assigned to the following teams. Please select all of the teams you are interested in.

The Quality Improvement Team: works with all Mental Health Plan programs to support documentation practices, facilitate clinical trainings and support activities, collect and analyze healthcare data, and assist programs to effectively ensure that State and federal requirements are being implemented.
The Triage Unit: focuses on early engagement, crisis management, clinical assessment and supportive services for individuals with serious mental illness, co-occurring substance use disorders and criminal justice involvement.
The SMART Team: supports clients who are CalWORKS Welfare-to-Work recipients who suffer from mental health, substance use and/or domestic violence issues which reasonably prevent them from looking for employment or maintaining employment. The team offers clinical assessments and provide individual/family/group therapy services and case management services.
The Integrated Care Clinic: serves adult clients with serious and persistent behavioral health issues. The mental health clinician provides clinical assessment, diagnosis, and treatment planning and assist in determining levels of care including involuntary holds, provide individual and group therapy when indicated, and facilitate brief case management.
The Children’s Full Service Partnership Team: is comprised of a multidisciplinary team that provides intensive mental health services to children and families in the home and community. This team members work collaboratively with the family and other ancillary services to provide a team approach to meet the needs of the child and family.
The Adult Full Service Partnership Team: provides Assertive Community Treatment (ACT) to adults who have been recently hospitalized, incarcerated, or are at risk of being hospitalized due to the severity of their mental health symptoms in combination with insufficient social supports and co-morbid medical and/or substance abuse conditions.
2

If you selected more than one team/unit in Question 1, please rank in order of preference the team/units you selected starting with Team/Unit 1, Team/Unit 2, etc.

Please note that the response you provide will not preclude you from future employment opportunities.

If you only selected one team/unit in Question1, please indicate "n/a."

3

This recruitment requires proficiency in speaking, reading, and writing in the Tagalog language. Applicants will be required to demonstrate such proficiency. Are you proficient in speaking, reading, and writing in Tagalog?

Yes No
4

Some vacancies are designated as Extra Help positions. Extra help positions are used to augment staffing and are typically less than 29 hours per week. Extra Help employees cannot work more than 999 hours in a fiscal year, are excluded from civil service and shall not have the property rights to regular or continued employment. Are you willing to accept extra help employment?

Yes No
5

I understand that I must submit a copy of the following by the final filing deadline:

  • Proof of the required Master's degree. All applicants must submit a copy of their degree (verifying the degree, date earned and area of specialization) or transcripts (official/unofficial verifying the student, institution, and date and degree conferred).
  • Verification of acceptance by the California State Board of Behavioral Science Examiners as a candidate for licensure (registered intern/associate) as either a Marriage and Family Therapist Intern (MFTI) or Associate Licensed Clinical Social Worker (ALCSW).

I will be submitting all of the above in the following manner:

 

Uploading to my employment application prior to submittal
Emailing to recruitment@solanocounty.com
Faxing to (707) 784-3424