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Supplemental Questionnaire

Last Name
First Name


Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.


Do you possess a master's degree in Public Health from an accredited college or university, with a specialization in a public or community health education program accredited by the Council on Education for Public Health?

Yes No

If you answered Yes, please provide the following information:

  • Name of college or university from which you graduated
  • Degree obtained
  • Specialization

This position requires a valid California Driver's License.  Do you possess a valid California Driver's License?

Yes No

If you answered Yes, please provide your license number and expiration date.


Please describe any experience you may have in assessing public health education needs, and the planning and implementing of community health programs and services.