Official SealDepartment of Budget and Management


#18-001344-0003
Supplemental Questionnaire

Last Name
First Name
1

Do you have experience with Occupational safety and health?

Yes No
2

Why do you want to be a MOSH compliance consultant?
3

Do you have any fear of public speaking? Yes or No, If not, list any experience you
may have.
4

This position requires you to perform consultation surveys in correctional facilities, and other similar institutions, do you have a problem performing consultation surveys in these types of establishments?
Yes No
5

Do you have a car available at all times and a valid driver's license?
Yes No
6

This job may require overnight stay or extended travel for up to 2 weeks for the purpose of training, conducting inspections etc. Do you have any conflicts that would prohibit you from traveling?
Yes No

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