Official SealHuman Resource Services Department

Supplemental Questionnaire

Last Name
First Name

Thank you for your interest in the position of Health Care Program Administrator II. 


The following supplemental questions will be used to determine your qualifications related to the general Health Care Program Administrator II recruitment. Applicants for this position are required to submit responses to the following supplemental questions. Your completed response to this 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. 

Responses should be specific, thorough and succinct.  A lack of adequate detail in the supplemental questions and in your application may result in failure or disqualification for this recruitment.  Clarity of expression, 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 a thoroughly completed employment history and supplemental 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 are required to submit complete responses to the supplemental questions and a complete application in order to be considered for this recruitment.
Do you understand the above statement?

Yes No

Describe your experience planning, implementing and evaluating a large service program.  In your response, please include:

  • The type of service program;
  • The methods/processes you used for quality improvement of the programs you planned and/or implemented;
  • The dates of employment;
  • The employer, your title, and your specific role.

Describe your experience developing and monitoring program/service budgets. Please mention the size of the budget you monitored, challenges and barriers you faced, and how you overcame those challenges.


Describe your experience supervising multidisciplinary staff.  Please include the different levels of staff you supervised and provide an example of a situation in which you had to deal with difficult staff.  What was the problem, what steps did you take to resolve the problem, and what was the outcome?


Describe a project that you were responsible for in which you needed to recruit and sustain a diverse group of peers, community partners, official and/or health care staff.  How did you recruit the members, how did you sustain their support, and how did you keep the momentum going?


Describe your experience with staff development processes.  Please provide examples and explain what staff development method(s)/strategy(ies) you practiced for a large program. What was/were the outcome(s)?


Tell us about an experience working with a population from a different background than your own. How did you increase your awareness of personal and cultural differences? How did this information affect your actions?



The following supplemental questions will be used for selective certification purposes only, for candidates eligible for referral, to determine qualifications related to the specialty designation criteria identified. This section of the supplemental questionnaire will not have an impact on the assessment of your application for minimum qualifications, nor on the screening for best qualified examination component. If you do NOT possess the qualifying experience/licensure below, please mark "no," and respond with "N/A" in the following text box. If you possess some, or all, of the qualifying experience/licensure below, please mark "yes" for the designation criteria you meet, and detail your qualifying experience/licensure in the following text box.

Do you understand the above statement and instructions for the following supplemental questions?  

Yes No

Homeless Program Specialty

Do you possess two (2) years of experience providing services to vulnerable populations (homeless or indigent)?

Yes No

If yes, please detail your qualifying experience, including the employer(s) where you gained the experience and the dates of your employment.


Quality Improvement Specialty

Do you possess one (1) year of experience in quality improvement, quality assurance, and quality management of health care systems including experience using outcomes for program improvement in a health care system?

Yes No

If yes, please detail your qualifying experience, including the employer(s) where you gained the experience and the dates of your employment.


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