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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 MDH Allegany County Health Department's Behavioral Health Division.  Are you currently an employee of the ACHD's Behavioral Health Division?

Yes No

Describe your experience performing clerical duties.

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must be reflected in your application.  If you do not have this type of experience, put N/A in the box below.

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