Official SealDepartment of Budget and Management


#20-000713-0002
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.

Do you possess a Bachelor's degree in Nursing, Social Work, Psychology, Education, Counseling or a related field?

Yes No
2.

What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.

3.

Explain your professional work experience related to treatment and services to persons with alcohol or other substance use addiction.

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.

Do you possess any of the following licenses or certifications?  If "Yes", please mark the licenses or certifications that you currently possess.

CSC-AD
LCADC
LCSW
LCSW-C
LCPC
LCPC-S
5.

Describe your clinical experience with substance use disorder, working with the adolescent/young adult population.

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.

6.

Describe your knowledge and experience utilizing evidence-based practice interventions.

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.

7.

Describe your experience researching, writing, coordinating, and tracking the grant application process to include identifying, cultivating and soliciting new grants.

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.

8.

Describe your experience with the overall management of proposals using known grant management systems and electronic databases.  Please include the name of the systems and databases used in your answer.  

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.

9.

Please describe experience which required you to demonstrate strong time management, priority
setting and organizational skills. 

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. 

 

10.

Describe your experience working professionally and collaboratively with state-wide systems.

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. 

11.

Describe your experience which demonstrates your use of effective communication skills, both written and verbal.  Include name of employer, dates of employment and job duties.  Indicate where this experience is referenced on your application.  If no experience, indicate N/A.

12.

Describe your work experience handling confidential information.  This experience must also be reflected in your application.  If you do not possess this type of experience, please indicate N/A in the text box below.

13.

Describe your experience utilizing computers and entering data into an electronic tracking system.

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 experience in this area, indicate N/A.


Powered by JobAps