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#17-004414-0005
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.

Do you possess a Bachelor's degree from a accredited college or university in Computer Information Technology, Management Information Systems or other information technology related field, to include coursework in local or wide area computer networks?

Yes No
2.

List coursework completed in local or wide area computer networks (LAN/WAN).  Please include the college/university where the course was completed, course title, date taken (i.e., Spring 2014, Summer 1995, Fall 2001) and the grade received for each course.  (If not applicable, put N/A in the box below.)

3.

Describe your experience planning, integrating and maintaining software and hardware for local or wide area computer networks.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

4.

Please describe your supervisory experience.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised.  If you do not possess this experience, enter N/A.

5.

Describe your IT experience within the Healthcare field (Patagionia Health, EMR, etc.).

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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