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#18-004395-0014
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 clerical experience applying policies in a medical care, health insurance or Federal or State entitlement program.

Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below.

2

Describe your experience with MMIS and CARES.

Please include name of employer, job title, dates of empl.oyment, 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

Describe your experience working in a correctional setting. 

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.

4

Describe your experience working as a case manager.

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.

5

Do you possess a valid Maryland driver's license?

Yes No

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