**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.
Do you possess a Bachelor's degree in Nursing? (If Yes, indicate this clearly on your application.)
Yes
No
2.
Do you possess a current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?
Yes
No
3.
If yes, please provide your license number, expiration date and state (if it is a compact state). Not providing this information may result in disqualification. If you do not possess this license please write N/A.
4.
Do you have experience in one or more of the following types of programs or units: Ambulatory Care, Assisted Living and Adult Medical Day Care, Developmental Disabilities, Hospital and HMO, or Long Term Care (Nursing Home)?
Yes
No
5.
If you answered "yes" to the previous question, please describe your experience working in these programs. Be sure to indicate the type of program(s) that you worked in, name of employer, job title, and hours worked per week for each relevant position. This information must also be reflected in your application. Do not copy and paste from your resume. If you do not have this experience, put N/A in the box below.
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