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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.**



This recruitment is limited to current employees of the Frederick County Health Department's Health Care Connection and Preparedness Division. Are you a current employee with FCHD's Health Care Connection and Preparedness Division?

Yes No

Describe any lead or supervisory experience that you possess.

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.


Describe your knowledge of and/or experience with Medicaid Programs, including Administrative Care Coordination Unit (ACCU).

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.


Do you possess a motor vehicle operator’s license valid in the State of Maryland?

Yes No

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