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#18-005483-0017
Supplemental Questionnaire

Last Name
First Name

 

Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.


1

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
2

Please provide your license number and expiration date in the box below.

3

Do you possess a master's degree in nursing or a related field?

Yes No
4

What field of study is your master's degree in?

5

Do you possess a bachelor's degree in nursing or a related field?

Yes No
6

What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.

7

Please describe your experience in psychiatric Nursing.

8

Describe your experience in a supervisory, teaching or administrative capacity. 

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.


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