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#26-002725-0006
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.

This recruitment is limited to current employees of the Kent County Health Department.  Are you a current employee of the KCHD?

Yes No
2.

Describe your professional experience assisting in the coordination of a health-related program or referring people to governmental and private resources.

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.

Per COMAR Regulation 10.09.48.05E, a Coordinator of Community Services shall meet one of the following criteria. Please indicate which of the three criteria you meet by checking the appropriate box.

Bachelor's degree from an accredited college or university in a Human Services field
Associate's degree from an accredited college or university with two (2) years experience in a Human Services field
Seven years of experience in a Human Services field
4.

Describe your experience in a human services field.

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.

5.

Describe your experience working with individuals with developmental disabilities, including familiarity with person-centered planning, behavior support and daily living support.

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 with state regulations related to developmental disabilities services.

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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