Official SealDepartment of Budget and Management


#19-005477-0014
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.

Do you possess a bachelor's degree or higher from an accredited college or university?

Yes No
2.

In which field of study is your degree? If you do not have a degree, enter N/A.

3.

Describe your professional experience in health care policy, public health, health care administration or closely related field.

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 at a supervisory or management level. 

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 Master's Degree from an accredited college or university?

Yes No
6.

What field of study is your master's degree in?

7.

Describe your experience managing large budgets and performing fiscal analysis.

Please include name of employer, job title, dates of employment, and hours worked per week.  This information must be reflected in your application.  If you do not possess this experience, put N/A in the space below. 

8.

Describe your knowledge of and experience with the nursing facility industry.

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 this experience, put N/A in the space below.


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