GENERAL INFORMATION

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* 1. Experience (check all that apply)

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* 2. Applicant Information

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* 3. Previous Employers in Health Care (Name, City/State, Years)

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* 4. Have you ever worked for an organization that received an AHCA/NCAL National Quality Award?

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* 5. If yes, please check which Level(s) and the corresponding year(s):

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* 6. Please describe your involvement in the preparation of the applications for these awards.

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