Official SealHuman Resource Services Department


#23-5305-01
Supplemental Questionnaire

Last Name
First Name
 

IMPORTANT:  Applicants for this position are required to submit responses to the following supplemental questions. By selecting yes below, you certify your understanding that all applicants must meet minimum qualifications in order to move forward in the process.  Do you understand the above statement?

Yes No
 

By selecting yes below, you certify your understanding of the following:

  • Candidates who possess the minimum qualifications for the class will be placed directly on the eligible list based on an evaluation of education, training, and experience only;

 

  • This recruitment may be reopened as necessary and the names of additional candidates merged onto the existing list according to an evaluation of their application material.
Yes No
1.

Do you possess any state license(s), certificate(s) and/or registration(s)  which qualify you for the position. Indicate serial number, date issued, expiration date for each.

2.

Do you have additional job-related training and/or education beyond that required by the minimum qualifications?

If yes, indicate additional training/education.

3.

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?

Yes No
4.

Do you claim veterans’ service connected disability?

Yes No

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