Include complete responses to all of the following items for each experience you held, SEPARATELY: (a) Your official job title; (b) Employers name, type of establishment (e.g., clinic, hospital, school, private practice, etc.), and primary services provided and to whom (describe clientele); (c) Department you worked in, the job titles (and how many of each) of all other personnel in that department, and the role of your position as compared to others in your department; (d) Supervisors official job title, qualifications (e.g., MSW, Licensed Psychologist, etc.), and duties (briefly describe); (e) Complete dates of employment while in this position (from mm/yy to mm/yy); and, (f) Average hours you worked per week. Temporary Assignment: Claims of Temporary Assignment (TA) experience to meet the minimum qualification requirements must be verified and attached to the application using one of the options below:
A copy of the applicant's TA History Report or equivalent system-generated report;
A signed letter from the applicant's supervisor that includes the applicant's name, his/her TA job title, the TA start and end dates (from mm/yy to mm/yy), his/her specific TA duties performed, and either the TA hours worked per week or total TA hours worked; or,
Copies of the applicant's signed SF-10 Forms.