Official SealDepartment of Budget and Management

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.**



Do you have three years experience in food preparation at a public or government establishment, such as a restaurant or hospital involving the cooking of meats and vegetables and the preparation of salads and beverages?

Yes No

Please describe your experience preparing food involving the cooking of meats and vegetables; the preparation of salads and beverages in an institutional setting such as hospitals, nursing homes, universities or correctional facilities. If you have this experience, also provide the name of the employer and dates of employment and hours worked per week where you performed these functions. If you do not have this experience, please enter N/A.


Do you possess a current ServSafe Certification?  If yes, please provide the date you were issued the ServSafe Certification. If no, enter N/A.

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