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#24-002586-0052
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

Describe your experience as an emergency manager and life safety in a healthcare hospital setting.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

2

Do you possess certification as a Healthcare Emergency Professional? If so, please upload and/or clearly indicate it on your application.

Yes No
3

Describe your professional work experience with the Maryland Department of Emergency Management Operations.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.


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