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#17-004394-0026
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.***


1.

Frequent travel is required of this position.  Are you willing to travel?

Yes No
2.

Explain your experience in applying policies in a medical care, health insurance or federal or State entitlement program.   Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below. 


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