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#0818-RS7060-01
Supplemental Questionnaire

Last Name
First Name
1.

Have you graduated from an accredited four-year college or university with a degree in social services, public health, public or business administration or related field?

Yes No
 

If yes, please indicate degree and major.

2.

This position requires two years of experience in program planning, program administration, contract management, or social casework and counseling in a social service agency providing services to adults, the elderly, or economically disadvantaged. 

Do you possess two years of the required experience as mentioned above?

Yes No

 

If you answered yes,  provide detail regarding your experience in the areas below.  Include employer name, job title, dates of employment and hours worked per week.  If you no not have professional experience in the subject area, type "n/a".


 

Program Planning

 

Program Administration

 

Contract Management

 

Social casework and counseling in a social service agency providing services to adults, the elderly, or economically disadvantaged.

3.

SUBSTITUTION: 

Additional qualifying experience may be substituted for the education on a year-to-year basis; a master's degree in the qualifying fields may be substituted for one year of the experience.  If you are using this substitution to qualify, include your relevant experience below.