Official SealHuman Resource Services Department


#18-0305-01
Supplemental Questionnaire

Last Name
First Name
 

Applicants for this position are required to submit responses to the following supplemental questions.  Your completed responses to the supplemental questionnaire will be evaluated to determine your qualifications and must be completed properly in order to be given full consideration for the next phase in the selection process. Additionally, your responses will also be evaluated and used in the selection process in order to identify the best qualified applicants.

Responses should be thorough and specific.  A lack of detail and explanation in the supplemental questions and in your application may result in failure or disqualification for this position.  Clarity of expression, content, experience, grammar, spelling and the ability to follow instructions will be considered in the evaluation process.  A resume will not be accepted as a substitute for properly completed responses.

Information provided in your responses to the supplemental questionnaire regarding your employment experiences must also be detailed in the Work Experience section of the application for this recruitment.  Please be sure to list all employers and required information, on your application, especially if you are referencing those employers in your responses to the supplemental questions.

By selecting yes below, you certify your understanding that all applicants must submit a complete application and complete responses to the supplemental questions in order to be considered for this recruitment. Do you understand the above statement?

Yes No

 

(Responses to supplemental questions #1 and #2 below will only be used to determine whether or not applicants meet the announced minimum qualifications for this position).


1.

This position requires possession of a current Registered Dietitian (RD) certification and good standing with the Commission on Dietetic Registration. In the space provided below, please provide your registration number, issuance and expiration dates.

2.

This position requires possession of a current Certified Diabetes Educator certification issued by the National Certification Board for Diabetes Educators (NCBDE). In the space provided below, please provide your certification number, issuance and expiration dates.

3.

Describe your experience planning, administering and evaluating diabetes service programs.  In your response, please detail the target populations, stakeholders involved, marketing approaches and actions you took to ensure programmatic goals were met.

4.

Describe a problem you encountered in the service delivery and/or coordination of diabetes services. In your response describe the problem, the resolution, and the factors you took into consideration in resolving the problem.

5.

Describe a training event or program that you developed and implemented. Who was the target audience?  What were the intended outcomes?  How did you measure the overall success of the training?

6.

Describe a situation in which you sought out a partnership agency in order to better meet the needs of a client. Why was the relationship necessary? What steps did you take to build the relationship? What was the end result?

7.

Describe a time when you used data to drive a decision affecting diabetes programs or services in which you made the final determination. In your response describe the situation, the type of data used, as well as the outcome of the decision you made.

 

The supplemental questions were designed to elicit your experience as it relates to the current recruitment in order to identify the best qualified candidates for this position. Only the best and most suitably qualified candidates will be invited to participate in the oral interviews.

By selecting yes below, you certify your understanding that all applicants who meet minimum qualifications are not guaranteed to move forward in the process. Do you understand the above statement?

Yes No

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