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#18-002432-0001
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.

Do you possess a current license as a Registered Environmental Health Specialist (formerly Environmental Sanitarian) from the Maryland Board of Environmental Health Specialists (formerly known as the Maryland Board of Environmental Sanitarians)?  If yes, please include a copy of your license with your application.  Indicate your license number and expiration date in the box below. If you do not possess this license, please put N/A in the box below.

2.

Describe your experience performing inspections and investigations to ensure compliance with environmental health laws and regulations. 

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

3.

Do you possess at least one year of supervisory experience?

Yes No
4.

Please describe your supervisory experience.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised.  If you do not possess this experience, enter N/A.


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