**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 in Nursing, Social Work, Psychology, Education, Counseling or a related field?
Yes
No
2
Do you possess a Master's degree in health or human services?
Yes
No
3
Describe your professional work experience in health services. 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 professional experience related to the treatment and services for mentally ill patients. 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 nursing or therapy experience working in a psychiatric or substance abuse treatment setting.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
6
Do you possess a nursing or therapist license? If so, please include the type of license, license number and expiration date below. You may also upload your license to your application.
7
Describe your experience with DSM-5 and ASAM.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
8
Describe your experience with analytical thinking and establishing and fostering collaborative relationships.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
9
Describe your experience with multi-tasking, planning, and leading a project from implementation to completion.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
10
Describe your skills in time management, communication and organization.
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.
11
Please describe your experience working independently and with a team. This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.
Department of Budget and Management