Official SealHuman Resource Services Department


#18-5665-01
Supplemental Questionnaire

Last Name
First Name
 

IMPORTANT:  Applicants for this position are required to submit responses to the following supplemental questions. 

By selecting yes below, you certify your understanding that all applicants must meet minimum qualifications in order to move forward in the process.  Do you understand the above statement?

Yes No
1.

Please describe any additional job-related experience in working with Environmental Health issues with regulatory agencies (for example: Regional Water Quality Control Board, Law Enforcement Agencies, State Food & Drug Department, Planning, Zoning & Building Departments, Alcoholic Beverage Control or Sanitary Districts).

2.

Please list any State license(s), certificate(s) and/or registration(s) you possess which qualify you for the position. Indicate serial number, date issued, and expiration date for each.


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