Official SealDepartment of Budget and Management


#21-005570-0004
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 60 credit hours from an accredited college or university with a minimum of 12 credit hours in mental health, health, human services, education, or related behavioral sciences including six (6) credit hours in psychology, counseling, addictions or mental health?  Please attach transcript to application.  Unofficial transcripts acceptable.
Yes No
2.

This position may be assigned to day, evening or rotating shifts to include holidays and weekends and may be subject to call-in and overtime based on staffing needs and program responsibilities.

Are you willing to work this schedule?
Yes No

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