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Human Resources Department
#19-333190-02


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.

How many years of experience do you have working with adults with serious mental illness (SMI) and co-occurring substance use who are reintegrating back into society from either jails, institutions, or crisis?

No experience
Less than 1 year
1 to 3 years
More than 3 years

2.

Do you have experience using the following psychosocial techniques?


 

Motivational Interviewing

Yes No
 

Cognitive Behavior Therapy

Yes No
 

Dialectical Behavior Therapy

Yes No
 

Eye Movement Desensitization Reprocessing Therapy

Yes No
 

Assertive Community Treatment

Yes No
3.

How many years of experience do you have working with multi-disciplinary teams for adults with serious mental illness and co-occurring substance use who are reintegrating back into society from either jails, institutions, or crisis?

No experience
Less than 1 year
1-3 years
More than 3 years

4.

Does your multi-disciplinary team experience include working with any of the following?


 

Public Defenders

Yes No
 

Courts

Yes No
 

Hospitals

Yes No
 

Other institutional settings

Yes No

5.

Do you have experience using the following interventions?


 

Motivational Interviewing

Yes No
 

Harm Reduction

Yes No
 

American Society of Addiction Medicine Criteria for Assessment

Yes No
6.

How many years of experience do you have working with multi-disciplinary teams for children?

No experience
Less than 1 year
1-3 years
More than 3 years

7.

Does your multi-disciplinary team experience include working with any of the following?


 

Community-based services

Yes No
 

County Behavioral Health

Yes No
 

County Child Welfare Services

Yes No

8.

Do you have experience working in a community-based agency or county mental health setting serving the following populations?


 

Children

Yes No
 

Adults

Yes No
 

Juvenile Sex Offenders

Yes No
 

Dual Diagnosed

Yes No
9.

Do you have experience in Quality Improvement projects related to behavioral health care or in a behavioral health work setting?

No experience
Less than 1 year
1-3 years
More than 3 years
10.

Do you have experience applying State or Federal regulations, or agency policy regarding Medi-Cal Specialist Mental Health Services?

Yes No
11.

Do you have experience using behavioral health outcomes data?

Yes No
12.

Some positions require bilingual skills in Spanish.  Applicants who indicate bilingual skills in will be required to demonstrate proficiency in speaking, reading and writing in Spanish.      

Are you proficient in speaking, reading and writing Spanish?   

                 

Yes No
13.

Some positions require bilingual skills in Tagalog.  Applicants who indicate they have bilingual skills will be required to demonstrate proficiency in speaking, reading and writing in Tagalog.      

Are you proficient in speaking, reading and writing Tagalog?  

Yes No