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#24-000532-0001
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.

Please describe your experience in the construction and or/manufacturing (i.e. machine shop, fabricating facilities, textiles, etc.) fields; and/or experience performing safety and health inspections, identifying and correcting hazards, and completing job hazard analyses. Please describe in detail and list employers and dates of employment. If no experience, indicate N/A.

2.

Have you completed an accredited certificate program in occupational safety and health? If yes, please indicate certificate or license. If no, indicate N/A.

3.

Have you obtained the following certifications in occupational safety and health (CSP, ASP, OHST, CHST)? If yes, please indicate certificate or license. If no, indicate N/A.

4.

We have positions available in the following office locations: Hagerstown, MD and Hunt Valley, MD. Which office do you prefer?


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