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#21-004435-0002
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

Please describe your supervisory experience.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised.  If you do not possess this experience, enter N/A.

2

Describe your experience with medical billing. Please include name of employer, job title, and dates and hours worked with your description.  If you do not possess this experience, put N/A in the box below.

3

Describe your experience working in a call center. Please include name of employer, job title, dates of employment and hours worked per week. If you do not possess this type of experience, indicate N/A.


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