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#22-003184-0010
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

Describe your administrative staff or professional work experience.

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.

2

Describe your experience with the following:  the supervision of other employees, overseeing and coordinating the general operations of a unit, applying rules and regulations, or exercising responsibility for the development of policies or procedures.  

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. 

3

Do you have supervisory experience? If yes, please describe in detail and include name of employer(s) where you gained this experience, dates of employment, and relevant job duties. If no, please enter N/A.

4

Describe your experience working within the field of epidemiology.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box.

5

Describe your experience in the Maternal and Child Health (MCH) field.

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.


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