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#25-005067-0002
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 experience conducting investigations in the areas of health care, insurance, medical malpractice or other related investigative experience.

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 research and organizational skills.

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

3.

Describe your experience assessing accurate documentation and record keeping.

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.

4.

Describe your experience communicating effectively with patients, professionals, other healthcare workers (including co-workers and staff of other agencies), and the public.

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.

5.

Describe your experience independently planning, organizing and executing assigned tasks.

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.

6.

Describe your experience exercising independent judgment and discretion regarding assigned tasks.

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.

7.

Describe your experience preparing and presenting reports and/or recommendations clearly and concisely.

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.

8.

Describe your experience maintaining confidentiality of sensitive information.

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.

9.

Describe your technological experience including the basic uses and capabilities of computers, information technology and data security.

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.


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