Department of Budget and Management

**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.**

Are you currently licensed as a Dentist by the Maryland Board of Dental Examiners?

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

Describe your experience in the practice of dentistry.  Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

Please describe in the box below your experience in a public health dental setting.  Please include the name of employer, job title, dates and number of hours worked.  This information must also be included on your application.  If you do not have this experience, please enter N/A in the field below.