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#24-000928-0006
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 administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

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. 

2

Describe your experience with computers.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

3

Describe your experience with automated accounting systems and spreadsheet software.

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.


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