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#24-005165-0009
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***


1.

Do you have experience providing career counseling and case management?  If yes, please include name of employer, job title, dates of employment, and hours worked per week.  This information must also be reflected in your application.  If no, indicate N/A. 

2.

Please describe your professional experience working with individuals with disabilities.  Please describe this experience and include name of employer, job title, dates of employment, and hours worked.  If you do not have this experience please enter N/A in the box below.  This experience must also be reflected in your application.

3.

Please describe your experience in the VR and/or Human Services related field. Please include name of employer, job title, dates of employment, and hours worked per week.   This experience must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.


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