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#17-002818-0016
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
Are you bilingual in Spanish and English?
Yes No
2

Describe your customer service experience with clients, patients and/or providers in a health setting.

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.

3

Describe in 1-3 paragraph(s), your experience participating and/or presenting at health fairs or events.

Do not copy and paste from your resume. 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.

4

Describe in 1-3 paragraph(s), your experience interacting with public and private stakeholders.

Do not copy and paste from your resume. 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

Choose the answer that best describes your level of experience using Microsoft Word.

Expert
Advanced
Intermediate
Beginner
6

What is your knowledge of Microsoft Excel?  (Check one)

Expert
Average
Basic
None
7

Please identify your level of proficiency in Microsoft Outlook.

Beginner
Intermediate
Expert
No experience
8

What is your knowledge of Microsoft PowerPoint?  (Check one)

Expert
Average
Basic
None

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