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#19-002595-0002
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 in the box below your experience providing supervision and guidance to youth in a juvenile facility or juvenile services community program for at-risk youth or in a correctional setting. Provide the dates of employment and the name of the employer where you performed this responsibility.  If you do not possess this experience, enter N/A.   (TextBox)

2

Describe in the box below your experience exercising supervisory responsibility over other staff providing services to youth.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised and explain your supervisory duties.  If you do not possess this experience, enter N/A.  (Text Box)


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