Official SealDepartment of Budget and Management


#21-005479-0012
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 possess a Bachelor's degree from an accredited college or university?

Yes No
2.

Do you possess a Master's Degree from an accredited college or university?

Yes No
3.

Describe your managerial experience in the field of health care, public health, human services or related field.

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 in Long Term Care.

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.

5.

Describe your experience working in a large matrixed organization.  

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


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