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#17-005482-0025
Supplemental Questionnaire

Last Name
First Name

 

Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.


1

Do you possess a Master's Degree from an accredited college or university?

Yes No
2

What field of study is your master's degree in?

3

Do you possess a Doctorate degree?

Yes No
4

Describe your professional health or human service experience.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

5

Describe your experience at a supervisory or management level. 

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below. 

6

Describe your experience with psychological and behavioral supports for individuals with intellectual and developmental disabilities.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

7

Describe your experience with Positive Behavior Support strategies and initiatives that facilitate least restrictive techniques.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.


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