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#18-004052-0001
Supplemental Questionnaire

Last Name
First Name
1
Are you at least 21 years of age, or will be within the next six months?
Yes No
2

Are you a U.S. Citizen or Legal Resident Alien?

Yes No
3

Do you have a high school diploma or GED?

Yes No
4

Please indicate which Correctional Maintenance Officer I trade you qualify for:
 (Each trade requires two years of experience in the selected field.)

Maintenance Mechanic
Stationary Engineering
Sheet Metal
Refrigeration Mechanic
Plumbing
Painting
Metal Maintenance
Masonry
Grounds Supervision
Electronics
Electrical
Carpentry
Automotive Services
5

If you checked any of the trade jobs above, please describe your experience in detail.  Include names of employers and dates of employment, which should be reflective in your application.  If you do not have this experience, please enter N/A?

6

Did a Department of Public Safety and Correctional Services employee refer you to this position?

Yes No
7

If you answered yes to the question above, please indicate the following:
• Referring employee's full name
• Employee's work location/assignment
If you answered no to the question above, please enter N/A.


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