**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 in Nursing, Social Work, Psychology, Education, Counseling or a related field?
Yes
No
2
In which field of study is your degree? If you do not have a degree, enter N/A.
3
Please outline the work or experience you have which includes support services and programs for individuals with intellectual disabilities and/or other developmental disabilities. Detail duties and the dates these duties were performed. Give specific details.
4
Describe your experience and/or working knowledge of State Long Term Support Services (LTSS).
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
Describe your experience with billing and supervision of fee for service employees.
This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.
Department of Budget and Management