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Human Capital Management
#180912-X20A-03


Supplemental Questionnaire

Last Name First Name
 

 

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire.  The questions below will be used for scoring purposes in lieu of a written exam.


1.
What experience do you have conducting a needs assessment with community partnerships to determine appropriate theoretical basis to initiate programmatic and strategic planning?
I have performed this task independently as a part of my job.
I have performed this task as part of my job with assistance.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

2.
What experience do you have implementing evidence based health education curricula?
I have performed this task independently as a part of my job.
I have performed this task as part of my job with assistance.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

3.
What experience do you have evaluating the effectiveness of health education/promotion programs?
I have performed this task independently as a part of my job.
I have performed this task as part of my job with assistance.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
4.
What experience do you have in the development of grant proposals and related documents?
I have performed this task independently as a part of my job.
I have performed this task as part of my job with assistance.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

5.
What experience do you have establishing and maintaining partnerships with agencies, communities, or organizations in determining the need for specialized health education programs?  Check all that apply.
I have been involved with community partnerships to determine a need for health education programs.
I have been involved with partnerships in planning health education programs.
I have experience implementing and evaluating specialized health education programs.
I have developed health education programs with partnerships that have been sustained over time
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

6.
What experience do you have preparing and delivering public presentations?
I have performed this task independently as a part of my job.
I have performed this task as part of my job with assistance.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
7.
Please check all of the following media with which you have working knowledge and experience. (Check all that apply.)
Microsoft Excel or similar spreadsheet software
Microsoft PowerPoint or similar presentation software
Microsoft Word or similar word processing software
Microsoft Publisher or similar desktop publishing software
SmartBoard
I have no experience in any of the above.
8.
What experience do you have facilitating or leading meetings?
I have facilitated or led meetings at least once a month.
I have facilitated or led meetings a few times a year.
I have facilitated or led meetings on a few occasions.
I have no experience with this task.
 

Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

9.
Are you a Certified Health Education Specialist (CHES)?
Yes No
 
Please list your current certification number below or type N/A if the above answer was No.