Official SealDepartment of Budget and Management


#17-000312-0003
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a current Licensed Clinical Professional Counselor license from the Board of Professional Counselors and Therapists?
Yes No
2.

If you answered Yes to the above question, please provide your license number and expiration date in the space below.  If you do not possess a certificate of eligibility, please indicate N/A in the text box below.

Powered by JobAps