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#19-002419-0003
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Describe your experience evaluating, analyzing, researching and developing health care services, systems, policies and programs.

This experience must also be reflected in your application. If you do not possess this type of experience, please indicate N/A.

2

Describe your experience assessing unit performance in order to establish and implement action plans and objectives to meet established performance standards.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

3

Describe your experience evaluating program activities in order to ensure that activities are conducted as required to meet State and Federal process requirements.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

4

Describe your experience producing timely-written reports which accurately describe a topic or situation in a clear and concise manner.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

5

Describe your experience maintaining and using database information systems which aid in analyzing and evaluating performance standards.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.


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