Official SealHillsborough County Government

Supplemental Questionnaire

Last Name
First Name


Supplemental Questionnaire

INSTRUCTIONS: Completion of this supplemental questionnaire is REQUIRED. Please read each question carefully and provide clear and complete responses that accurately portray your education and relevant work experience. Your qualifications for employment will be evaluated based upon the information you provide in your responses below and then verified by our staff who will review your entire application for completeness and determine qualification status.

The employers and dates of employment that you list on this supplemental questionnaire MUST match the employers and dates of employment provided in the work experience section of your employment application. Failure to provide matching employer, and dates of employment may result in your application being "not qualified" for this recruitment.

IMPORTANT NOTE: "See Resume" is not an acceptable response to any of the open-ended questions on this questionnaire and will result in your application being "not qualified" for this recruitment.


Have you graduated from high school or do you possess a GED Certificate?

Yes No

Select the number of years of experience you possess working in a recreational, social, health, or aging services program.

5 years or more
4 years
3 years
2 years
1 year
No Experience

This position will require you to plan, organize, schedule and implement multifaceted older adult programs and activities in a Senior Dining Center setting. What specific experiences do you have in organizing these type of programs? Provide specific examples of the programs you’ve implemented.


This position requires interfacing with the community to assist in establishing partnerships, cultivating & fostering community relationships, and seeking donations. Give examples of your success in this area.


What types of computer software are you proficient in? Please list all application types and degree of proficiency.


What is your knowledge of the term ‘wellness dimensions’? Give 1-2 examples of activities you implemented with one or all of the wellness dimensions.


This position will require you to plan special events for active older adults with varying physical and mental ability levels. Provide specific examples of the types of events you coordinated and how you included variations in the event for persons with these limited abilities.


Do you possess a valid Driver's License?

Yes No


By checking the box above, I certify that all of my responses are true and complete, and any misstatement of material facts OR failure to completely answer questions or provide my employer with a copy of any licenses, certifications, or other documents listed on the job announcement will subject me to disqualification from the application process and/or dismissal from employment.

I also authorize investigation of all statements contained in my application, to include a formal background check that may require education and employment verification; criminal history; and motor vehicle driving report as may be necessary in arriving at an employment decision. Further, I acknowledge understanding that an offer of employment will be subject to successfully passing a drug screen and physical.

I also understand that once I submit my application for this recruitment, I cannot edit it later.