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#17-000931-0003
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

This recruitment is only open to current employees of the Department of Health and Mental Hygiene (DHMH).

Are you currently employed by DHMH?

Yes No
3

Describe your experience in medical assistance programs.

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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