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#24-004080-0001
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

Are you 21 years of age or older?
Yes No
2

Do you have a High School Diploma or GED?
Yes No
3

Are you a US Citizen or Resident Alien?
Yes No
4

Did a Department of Public Safety and Correctional Services employee refer you to this position?
Yes No
4a

If yes, please indicate the following:

Referring employee's full name.
4b

Employee's Work Location/Assignment

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