Official SealDepartment of Budget and Management


#20-003507-0001
Supplemental Questionnaire

Last Name
First Name
1

 Please describe your two years of experience in work requiring knowledge of the function, organization, procedures and governing laws and regulations of the Workers' Compensation Commission. Please provide the provide the name of the employer and the dates that the experience was gained (if you do not possess this work experience, enter N/A.)

2

Please describe any experience you have processing workers' compensation claims. Please provide the name of the employer and the dates that the experience was gained (if you do not possess this work experience, enter N/A.)


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