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#20-002722-0032
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.

Do you possess a bachelor’s degree from an accredited college or university in nursing, social work, psychology, education or counseling?

Yes No

 

If you responded YES to the above question, please upload a copy of your transcript(s) to the application.  Unofficial versions of transcript(s) are acceptable.


2.

If you do not possess a bachelor's degree from an accredited college or university in nursing, social work, psychology, education or counseling, in what field is your degree?

3.

Describe your professional experience in health services.

Please include name of employer, job title, dates of employment, and hours worked per week. This information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

4.

Describe your experience in a public health setting.  Include any experience in public health policy, planning and testimony.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

5.

This position may require the employee to work on occasional evenings or weekends for outreach purposes. Will you be able to work on occasional evenings or weekends for outreach purposes?

Yes No
6.

Are you bilingual in Spanish and English?  Are you fluent in Spanish and English, meaning that you must be able to speak, write, and understand both Spanish and English.  

Yes No

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