COUNTY OF LOS ANGELES – DEPARTMENT OF HEALTH SERVICES

HUMAN RESOURCES/RECRUITMENT AND EXAMINING OFFICE

SUPPLEMENTAL APPLICATION INFORMATION FORM

CLINICAL SOCIAL WORK CHIEF III: #Y9022B

(Martin Luther King Jr. – HarborHospital)

General Information: This supplemental application information form provides you the opportunity to fully and clearly explain your experience that has prepared you for the position of Clinical Social Work Chief III ((Martin Luther King Jr. – HarborHospital). This information will be used to determine the level and scope of your preparation for this position.

Instructions: Complete the supplemental application information form by responding to the questions listed below. Your response to each question should be type-written or legibly printed and should be no longer than one page (8.5”x 11”) per question. Each response must include the name(s) and address(es) of your employer(s), your job title(s), beginning and ending dates and the functions performed, including a description of your role, level of involvement, independence, and information about the size, complexity and level of accountability surrounding your experience. Attach this completed form and your written supplemental application information form responses to your completed standard CountyEmploymentapplication. Applications submitted without the supplemental application information form will be considered incomplete and will not be accepted. Furthermore, resumes and other unsolicited materials will not be accepted in lieu of these two documents.

  1. Describe your post MSW professional experience in a supervisoryadministrative capacity at the level of the County of Los Angeles classifications of Clinical Social Work Supervisor or Supervising Psychiatric Social Worker (see the job bulletin for a description of each classification).
  1. Attach an organization chart for each job you held as supervisor or administrator and include the employer information (name and address).
  1. Describe your experience at the level of a manager in planning, monitoring AND assessing clinical and/or psychiatric social work programs and services.
  1. Describe your experience at the level of a manager in developing and implementing policies and procedures for clinical and/or psychiatric social work programs and services.
  1. Describe your knowledge, length, and breadth of your experience at the level of a manager with Federal, State and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) regulations.
  1. Describe your experience in developing an annual budget to determine staffing, equipment, and supplies for clinical and/or psychiatric social work services. Include a brief summary that describes the process by which the budget is developed and approved and your role in this process.

CERTIFICATION OF APPLICANT: I certify that all statements made to this supplemental application information form and any attachments are true and correct to the best of my knowledge. I understand that any falsification or omission of material facts may subject me to disqualification or dismissal.

Signature: Date:

Print Name: Social Security No.:

Filename: Supp_CSWC3_Y9022B re