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Human Resources Department
#18-333110-01
Supplemental Questionnaire

Last Name First Name
 

 

This Supplemental Questionnaire will be used to determine applicants’ qualifications for this position and which will be a factor in determining whether they will continue in the recruitment process; therefore, applicants are encouraged to answer all questions thoroughly and completely. Omitted information will not be considered or assumed. Applicants who have no experience in a specific area are recommended to state "no experience in this area" or "N/A" instead of leaving the space blank.

Work experience listed in this area must also be listed in the body of the application.
1

Please indicate the areas in which you are interested in working. Choose all that apply.
Public Health
Family Health/Medical Services
Behavioral Health
Child Welfare
2

Please indicate the number of years of experience you possess in public health and clinical nursing.
No experience
Less than one year
At least one year but less than two years
At least two years but less than four years
At least four years but less than six years
At least six years but less than eight years
Eight years of experience or more