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Supplemental Questionnaire

Last Name
First Name


The Supplemental Questionnaire is part of the assessment process and will be considered in making a selection of candidates to be invited to the next phase of the assessment process.   Your application is considered to be incomplete unless this questionnaire is completed.



Please indicate whether you hold a valid Plans Examiner certificate issued by the International Code Council, and if yes, indicate the certificate number and expiration date in the section below.

Yes No
Please describe any training, certification or education related to this position, and provide certification/license numbers if applicable.

I have experience enforcing state building and zoning codes, laws, regulations and standards in the following areas (check all applicable):

Plan Review
Building Permit Processing
None of the above
Please indicate in the area below WHERE you obtained experience specific to PLAN REVIEW and  PERMIT PROCESSING, including DATES of employment.   If you do not have any experience, please write "no experience."
I have customer service experience in the following areas:
Working at a public counter providing information.
Working at a building and safety counter providing information.
Consulting with permit applicants to provide information.
Explaining complex codes, regulations or ordinances to the public.
None of the above.
Indicate where you obtained the experience above including employer, job title and dates of employment.
I certify that all of my responses are true and complete, and any misstatements of material facts, or failure to answer questions will subject me to disqualification from the testing process and/or dismissal from employment. 
Yes No