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#18-J05-001
Supplemental Questionnaire

Last Name
First Name

 
The Supplemental Questionnaire is part of the testing process and will be considered in making a selection of candidates to be invited to the next phase of the testing process.   Your application is considered to be incomplete unless this questionnaire is completed.

Please answer all questions below making sure to indicate where you obtained your experience, including the length of time (i.e., Employer/Job Title/Employment Dates).

1.
If you have completed any specific coursework or training in building construction or building inspection, please indicate the name of training, school or organization and date completed in the section below.  
2.
I have at least three years of experience in the following areas (check all applicable):
Building Construction
Building Inspection
Less than 3 years of experience in the areas checked above
No experience in either area
2a.
Indicate where you obtained the experience above including employer, job title and dates of employment.
3.
I have the following certificates issued by the International Conference of Building Officials (ICBO) or International Code Council (ICC):
Combination Dwelling Inspector
Building Inspector
Mechanical Inspector
Plumbing Inspector
Electrical Inspector
Other (list below)
None of the above
3a.
Indicate the issue and expiration date of acquired certifications, and list any additional certification related to this position.
4.
I have experience inspecting buildings and enforcing compliance with the following codes and laws (check all applicable):
Housing Code
Electrical Codes
General Land Use Standards
Mechanical Codes
Building Codes
CA State Energy & Accessibility Laws
Plumbing Codes
None of the above
4a.
Indicate where you obtained the experience above including employer, job title and dates of employment.
5.
I have experience in the following areas (check all applicable):
Reviewing and processing permit applications
Reading and interpreting building plans and specifications
None of the above
5a.
Indicate where you obtained the experience above including employer, job title and dates of employment.
 
I certify that all of my responses are true and complete, and any misstatements of material facts, or failure to answer questions will subject me to disqualification from the testing process and/or dismissal from employment. 
Yes No