|
CEREBRAL PALSY THERAPIST (OCCUPATIONAL)
Supplemental Questionnaire
A properly completed Supplemental Questionnaire must be submitted for
this examination along with an application. Failure to submit the Supplemental
Questionnaire will result in disqualification..
As stated on the job announcement, the examination consists of a review of
candidates' applications and supplemental questionnaires to verify possession
of minimum qualifications. those candidates who possess the minimum
qualifications for the class will be placed on the eligible list based on an
evaluation of education, training, and experience.
This questionnaire AND the application form will be used in
evaluating your qualifications and identifying your availability for
employment. Please fill both out completely and return them to the Human
Resource Services Department. Be very specific on the application and
questionnaire as to dates and employment history (month and year, hours per
week, and salary) where applicable.
| 1. |
Do you have additional job-related training
and/or education beyond that required by the minimum qualifications? |
|
|
| |
If YES, either attach an
8-1/2”x11” paper to this questionnaire indicating additional
training/education OR indicate response on the back of this questionnaire
|
| |
|
| 2. |
State license(s), certificate(s)
and/or registration(s) you possess which qualify you for this position.
Indicate serial number, date issued, and expiration date for each.
Attach copy of proof. |
| |
|
| 3. |
In regards to license certificate,
and/or registration, if the minimum qualifications for this position allow for
“eligibility to receive” or for a “waiver,” and you are
applying under this option, attach proof of eligibility. |
| |
Are you applying under this option? |
|
|
| 4. |
To claim veterans’ preference
points, attach a copy of honorable discharge (DD-214). If you claim
service-connected disability, also attach proof from the Veteran’s
Administration of current disability of 10% or more. |
| |
Do you claim veterans’ preference
points? |
|
|
| |
Do you claim veterans’ service connected
disability? |
|
|
| 5. |
EMPLOYMENT AVAILABILITY INFORMATION:
Information checked here is used for certification purposes only and does not
restrict department’s right to reassign employees to different shifts or
locations. If this availability section is also included on the application,
make sure the information checked is identical on both forms. |
| Please check the kind of employment
for which you are available. Check ALL that apply. |
|
|
Permanent Employment |
|
Full-Time Employment |
|
Intermittent (services as needed/on
call) |
|
|
Temporary Employment |
|
Part-Time Employment |
|
|
|
| Check All Locations You Will Accept
Initial Employment: |
|
|
All Locations |
|
Oakland |
|
Berkeley |
|
Alameda |
|
Albany |
|
|
Hayward |
|
Castro Valley |
|
San Lorenzo |
|
San Leandro |
|
Union City |
|
|
Fremont |
|
Newark |
|
Pleasanton |
|
Dublin |
|
Livermore |
|
| Check All Shifts You are Willing to
Work: |
|
|
All Shifts |
|
Regular Day Shift |
|
Rotating Shifts |
|
|
4:00 P.M. to Midnight |
|
Midnight to 8:00 A.M.. |
|
Weekends |
|
| CERTIFICATION OF
APPLICANT: I hereby certify that I am the author of
this questionnaire and that all information presented is true and based on my
background, skills, and experiences. I agree and understand that misstatements
or omissions of material facts herein may forfeit my rights to any employment
in the service of the County of Alameda. |
| SIGNATURE:
|
|
|
