INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA by xdu18397

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									           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA

                                     MENTAL HEALTH TECHNICIAN TRAINEE

    CANDIDATE NAME:

    SOCIAL SECURITY NUMBER:

    INTERVIEWER(S):

    TEST COORDINATOR:

    INTERVIEW DATE:

    LOCATION:




             KNOWLEDGE and EXPERIENCE                ÷3=                X 25% =


             JUDGEMENT and OBJECTIVITY               ÷6=                X 35% =


             ETHICS                                  ÷4=                X 30% =


             ORAL COMMUNICATION                      ÷1=                X 10% =




                                                                       SUBTOTAL

                                                                       x 10 =




                                              TOTAL INTERVIEW SCORE:




IL444-4767 (R-6-10)                                                               Page 1 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA


                                              PRELIMINARY QUESTIONS



   The Interviewer is to examine the applicant's job application for employment discharges, conviction disclosures, and any
   work experience with the state.

   The following Preliminary Questions are to be asked of each applicant prior to initiating the standardized Rutan Hiring
   Criteria and Interview Questionnaire Process.


   1.      Have you ever been fired or otherwise released from employment because of job-related problems?
           For example, poor work performance, tardiness, late arrival, abuse of time or problems with co-workers or
           supervisors?

           INTERVIEWER: Ensure the CMS 100 item 9.A is checked "yes" or "no". If yes, ensure a completed
           detailed explanation w/signature is in the file.


           Done

   2.      Did you report any convictions on your State Police Release of Information form?

           INTERVIEWER: Ensure the CMS 100 item 9.B is checked "yes" or "no". If yes, have the candidate complete
           and sign the supplementary conviction form.


           Done:


   3.      Have you ever been employed by the State of Illinois?
                                                                           Yes         No


           If yes, what agency?

           What division did you work in?

           What were your dates of employment?

           What was the title of position(s) held?

           What was your name at the time?

           Why did you leave?




IL444-4767 (R-6-10)                                                                                                 Page 2 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA

     INTRODUCTION


     INTERVIEWER:
     Explain the structured interview process to the candidate. The following is an example guide you may use.

             *        To identify the most qualifed candidates, and to ensure the process is as fair and as objective
                      as possilbe, I will be using a structured questionnaire.
             *        I will be asking the same questions in the same order to each candidate. I cannot clarify,
                      rephrase or explain a question.
             *        I can repeat the question so you can think about it and your response.
             *        I will be documenting your responses in order to score your interview, so don't be distracted by
                      me taking notes.
             *        Assume I know nothing about you or your background, so be as thorough as possible in your
                      responses.
             *        Let's begin.


     KNOWLEDGE and EXPERIENCE 25%

       INTERVIEWER: You must write down the candidate's response. Points are awarded based on their level of
       experience as numbered below:

                 1.     What type of experience have you had assisting individual's with basic living skills such as: dressing,
                        undressing, eating, bathing and general grooming? Experience can be personal, volunteer or work
                        related. Also, please indicate any training, certificates or degrees you may have in the health field.




                        1. No experience

                        2. Personal care with their family members or friends.

                        3. Direct Care experience in a hospital, nursing home, home health care, MH or DD facility, adult
                           day care, school, community provider, etc.

                        4. Same as #3, plus training or certification in health care, first aid, CPR.

                        5. Same as #3 & #4, plus possession of a CNA, EMT, LPN, Bachelor's degree in nursing, etc.


                        Score




IL444-4767 (R-6-10)                                                                                                  Page 3 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA

              2.         Describe your experience (paid, volunteer, personal) in planning, coordinating or participating in
                         recreational or social activities for others. Also, please indicate the length of time you have
                         performed these activities.




                   1. No experience

                   2. Participated in recreational activities with their family members or friends.

                   3. Participated in recreational activities as a volunteer for Big Brother/Sister, Boy or Girl Scouts,
                      YMCA, YWCA, etc.

                   4. Six months or less recreational or activity work experience gained at a MH or DD facility,
                      community provider, nursing home, hospital, day care, adult workshop, school, etc.

                   5. Same as #4, only more than six months of experience.


                   Score


              3. Describe any experience (paid, volunteer, or personal) you have in cleaning, housekeeping or other
                 janitorial duties. Also, please indicate the length of time you have performed these activities.




                   1. No experience

                   2. Personal home or those of family members or friends.

                   3. Six months or less professional (paid) duties in a restaurant, retail outlet, office or other which
                      requires clean or sanitary conditions for others.

                   4. Six months or less housekeeping experience in a military setting, hosptial, nursing home, MH or
                      DD facility, community provider, adult day care, school, etc.

                   5. Same as #3 or #4, only more than six months of experience.


                   Score



IL444-4767 (R-6-10)                                                                                                         Page 4 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA
     JUDGEMENT 25%

       INTERVIEWER: You must write down the candidate's response. If the candidate's response matches any of the
       statements given, place a check mark next to it. The number of checks equals the number of points awarded.
       Candidate will always score one point for Statement 1.

              1.      If you are selected for this position, the classroom training may include many things you do not know,
                      but need to learn as quickly as possible. Describe how you would learn the duties, responsibilities
                      and functions of this job quickly.




                              States that he/she would do nothing or states "I don't know".
                              Pay close attention and/or take notes.
                              Review training documents and/or read other training material.
                              Ask questions of instructors and/or meet with other trainees to review lessons.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




              2.      While conducting a vocational training program with a group of six recipients, one of the recipients
                      becomes frustrated and throws his books at another recipient. What would you do?




                              States that he/she would do nothing or states "I don't know".
                              Call for assistance and calm the recipients if necessary.
                              Attempt to find out what's wrong, then try to complete the training program.
                              Document incident in writing and/or verbally report it to your supervisor.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




IL444-4767 (R-6-10)                                                                                                Page 5 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA



              3.      Your supervisor asks you to complete a task that you have never performed before. What do you do?




                              States that he/she would do nothing or states "I don't know".
                              Immediately inform your supervisor that you have not performed that task before.
                              Ask for guidance and assistance in the proper way to complete the task.
                              Would only attempt to complete task with proper training.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




              4.      You are working your assigned shift and you witness a coworker swearing at an agitated recipient.
                      This coworker has been with the facility for many years and has always treated the recipients with the
                      utmost care. How would you handle the situation?




                              States that he/she would do nothing or states, "I don't know".
                              Step in to separate the recipient from the coworker and try to calm them down.
                              Make sure recipient is ok and tell coworker their behavior was not appropriate.
                              Report to my supervisor what I witnessed.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




IL444-4767 (R-6-10)                                                                                              Page 6 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA




              5.      You observe a coworker starting to lift an object that, based on training, should require two people.
                      What would you do?




                              States that he/she would do nothing or states, "I don't know".
                              Tell the coworker not to do it alone.
                              Immediately assist the coworker in lifting the object.
                              Speak to the supervisor in charge and ask for clarification.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score



              6.      You are in the gym playing basketball, responsible for a group of eight recipients with developmental
                      disabilities. Suddenly, two of the group begin physically fighting with each other. You are the only
                      technician in the immediate area. How would you handle the situation?




                               States that he/she would do nothing or states, "I do not know".
                               Immediately call for help.
                               Separate the fighting recipients, calm and redirect the group if necessary.
                               Document incident in writing and/or verbally report it to your supervisor.
                               Any other well-defined acceptable or appropriate response from the candidate.

                      Score




IL444-4767 (R-6-10)                                                                                                Page 7 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA

     ETHICS 30%

       INTERVIEWER: You must write down the candidate's response. If the candidate's response matches any of the
       statements that are given, place a check mark next to it. The number of checks equals the number of points
       awarded. Candidate will always score one point for Statement 1.


              1.      You are working your assigned shift when a new admission arrives on the unit. You observe the
                      recipient's guardian giving what appears to be money to another staff person and you hear the guardian
                      say, "take good care of my loved one". What do you do?




                              States that he/she would do nothing or states, "I don't know".
                              Tell the other staff to return the money to the guardian.
                              Politely inform the guardian it is our duty to give good care to all recipients.
                              Document the incident in writing and/or verbally report it to your supervisor.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




              2.      During your training program, you were instructed to only document after you actually provide a service
                      to a recipient. A more senior coworker states that it is permissible to document services before you
                      actually completed them. What do you do?




                              States that he/she would do nothing or states, "I don't know".
                              Mention to the coworker that you were taught differently in training.
                              Communicate to my supervisor what was presented to me or ask for clarification.
                              Document after services were provided exactly as instructed in training.
                              Any other well-defined acceptable or appropriate response from the candidate.

                      Score




IL444-4767 (R-6-10)                                                                                              Page 8 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA

              3.      You are leaving work for the day at the same time as your coworker. In your community, the school
                      year is just about to begin. You notice the coworker is carrying a box of State supplies, including pens,
                      markers, paper scissors and so forth to their car. What would you do?




                               States that he/she would do nothing or states, "I don't know".
                               Confront the coworker and ask them what they are doing.
                               Tell the coworker it is wrong to take State property.
                               Document the incident in writing and/or verbally report it to your supervisor.
                               Any other well-defined acceptable or appropriate response from the candidate.

                      Score



              4.      While going on lunch break, you observe a recipient alone in his wheelchair on the patio outside the
                      cafeteria. You know this individual should not be left alone outside. All other recipients, as well
                      as other staff, are in the cafeteria. How would you handle the situation?




                                States that he/she would do nothing or states, "I don't know".
                                Check to make sure the recipient is okay and not injured.
                                Bring the recipient inside and determine who was responsible for their care.
                                Document the indicent in writing and/or verbally report it to your supervisor.
                                Any other well-defined acceptable or appropriate response from the candidate.

                      Score




IL444-4767 (R-6-10)                                                                                                Page 9 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA



     ORAL COMMUNICATION 10%

       INTERVIEWER: The candidate's oral communication score is to be an overall assessment of the ability to clearly,
       thoughtfully, and concisely answer all questions contained within this standardized questionnaire.


              1. Oral communication skills were poor and minimal. Did not exhibit clear thought processes.
              2. Oral communication skills were less than satisfactory, but the candidate appeared to
                 understand and comprehend questions.
              3. Oral communication skills were satisfactory and the candidate displayed the ability to organize
                 their thoughts and responses.
              4. Oral communication skills were above average and the candidate exhibited the ability to
                 effectively communicate with others.
              5. Oral communication skills were excellent and the candidate exhibited superior comprehension.
                 Responses were thoughtful, clear and concise.

               Score




IL444-4767 (R-6-10)                                                                                                Page 10 of 12
            State of Illinois
            Department of Human Services

            INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA


                                                     FINAL QUESTIONS

   That was the last formal interview question, but I have a few additional follow-up questions.

   1. Are you still interested in this position?       Yes         No


   2. At this time, you should have a good understanding of this position. Is there anything, with or without a reasonable
      accommodation, that would prohibit you from performing the duties of the position?
                                                                                                Yes         No




   3. At what telephone number(s) can you be reached between the hours of 8:30 a.m. and 5:00 p.m. Monday through
      Friday?

        Home:                                      Work:

        Cell:


   4. If you are selected for a trainee position, how much notice will you need to give your current employer?



   5. Do you have any questions?




   TO ALL APPLICANTS: This concludes the end of the testing process.




IL444-4767 (R-6-10)                                                                                               Page 11 of 12
           State of Illinois
           Department of Human Services

           INTERVIEW QUESTIONNAIRE AND HIRING CRITERIA


                                  INTERVIEW AFFIDAVIT STATEMENT

                              (2nd Page of Candidate Evaluation Form)



      CANDIDATE NAME:



     TOTAL INTERVIEW SCORE:




     AFFIDAVIT: "I certify that the hiring criteria and interview questions related to this
     employment decision were developed prior to initiating the candidate interview process.
     Furthermore, I certify that political party affiliation, support or lack thereof were not
     discussed or considered at any point in the interview process."



      Interviewer Name (Print):           Interviewer Signature:               Interviewer Title:




      Test Coordinator (Print):           Test Coordinator Signature:          Test Coordinator Title:




                                                          DATE OF INTERVIEW:




                                                                        Print Form          Reset Form
IL444-4767 (R-6-10)                                                                                      Page 12 of 12

								
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