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#21-004395-0001
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 processing information regarding Medical Assistance eligibility, including MMIS, CARES, HBS and/or SAVE.

This experience must also be included on your application. Please be sure to 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.

2

Describe your experience using various Medical Assistance programs.

This experience must also be included on your application. Please be sure to 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.

3

Please detail your experience using Microsoft Word and Excel to perform your job duties. Include employer, duties and dates of employment.    This experience must also be reflected in your application.  If no experience, indicate N/A.


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