Official SealDepartment of Budget and Management


#18-004609-0006
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 degree in medicine from an accredited college or university?

Yes No
2.

Are you currently licensed to practice medicine by the Maryland Board of Physicians?  (If Yes, please submit a copy of your license or license verification with your application.)

Yes No
3.
Do you posses a current Board Certification?
Yes No
4.

Describe your medical practice experience. 

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. 

5.

Describe your demonstrated public health experience at either the federal, state or local level.

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.

6.

Describe your experience including responsibility for developing budgets, tracking expenditures, and staff recruitment and management.

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.

 

7.

Describe your experience related to cancer, chronic disease, tobacco and/or oral health.  

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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