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#21-001375-0015
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 have a High School Diploma?

Yes No
2

Do you have experience performing clerical duties in an office environment? Please explain in detail including dates and places of employment.

3

Describe your experience with customer service.

Do not copy and paste from your resume. 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

Describe your experience working with Microsoft Office and Google Suite applications. Please include name of employer(s), specific job duties performed, and dates of employment. This information must also be reflected in your application. If you do not have this experience, enter N/A.

5

Describe your experience working in a health care setting with persons with developmental disabilities. This experience should also be included in your application.  If you do not possess this type of experience, please indicate N/A in the text box.

6

Describe your experience with LTSS and/or PCIS2. This experience must also be included on your application.


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