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SENIOR NUTRITIONIST
Supplemental Questionnaire

As stated in the examination announcement for this position, a properly completed Supplemental Questionnaire must be submitted with an application. Failure to submit the Supplemental Questionnaire will result in disqualification. Applications and Supplemental Questionnaires must be in the possession of the Human Resource Services Department by 4:30 p.m. on the Last Day for Filing. Postmarks are not accepted.

The purpose of this questionnaire is for you to identify your qualifications and experience in job-related areas to verify further knowledge, skill or ability. It is critical that you fill out the Supplemental Questionnaire completely, listing all education, experience or special training which might demonstrate your qualifications in the rating areas.

PLEASE TYPE OR PRINT YOUR RESPONSES. If you need additional space, use 8-1/2” x 11” paper, attach this cover sheet, and put your name at the top of each page. Your answers should be concise, complete and clear. Grammar, clarity of expression and legibility will be considered in the evaluation process. Try to limit your responses to half a page for each question.

1. Name the public health agency in which you worked as a Nutritionist with the most autonomy. (Include: location, length of tenure, hours worked per week and the number of employees that you supervised, if any.)
 

2. Describe an agency program for which you had the most responsibility for its planning and evaluation.
 

3. Where did you complete your internship approved by the American Dietetic Association?
 

CERTIFICATION OF APPLICANT: I hereby certify that I am the author of this questionnaire and that all information presented is true and based on my background, skills, and experiences. I agree and understand that misstatements or omissions of material facts herein may forfeit my rights to any employment in the service of the County of Alameda.

SIGNATURE:

DATE

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