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#21-004522-0008
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 reviewing, verifying, recording, adjusting and balancing financial transactions. Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below.

2.

Describe your experience using Microsoft Outlook.  If you do not possess this type of experience, please indicate N/A in the text box below.

3.

Describe your experience with health care pre-cert and/or physician billing.  This experience must also be included on your application.  If you do not possess this type of experience, please indicate N/A in the text box below.


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