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#22-004395-0010
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

This recruitment is limited to current employees of the MDH's Office of Systems Operations and Pharmacy's Division of Claims Services. Are you a current employee of the MDH OSOP, Division of Claims Services?

Yes No
2

Describe your clerical experience applying policies in a medical care, health insurance or Federal or State entitlement program.

Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below.


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