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Human Capital Management
#180305-Y11B-H02


Supplemental Questionnaire

Last Name First Name
 

 

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire.  The questions below will be used for scoring purposes in lieu of a written exam.


1.
What experience do you have providing tracheal, catheter and breathing treatments?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

2.
I have work experience providing a nursing education program for a (Check all that apply.)
city.
county.
state.
federal agency.
I have no work experience providing a nursing education program.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

3.
What experience do you have assessing individual medical needs?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
4.
What experience do you have providing on-the-job training to nursing personnel?
I have provided on-the-job training as a regular part of my job.
I have rarely provided on-the-job training.
I have received some training on how to train others on-the-job.
I have no experience providing on-the-job training.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

5.
In what setting do you have experience providing job related classroom training as an instructor? (Check all that apply.)
Vocational Technical Institution
Accredited 4 year University
Community College
Medical facility
I have no experience providing job related training.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

6.
What experience do you have gathering data in the medical field?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
7.
What experience do you have developing and implementing appropriate aspects of a plan of care?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
8.
What experience do you have administering medications in a professional work environment?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

9.
What experience do you have assisting in reporting and recording health status of patients for the oncoming shift?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
10.
What experience do you have in the evaluation of responses to nursing interventions?
I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job with some supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below.