Official SealDepartment of Budget and Management


#18-004247-0012
Supplemental Questionnaire

Last Name
First Name
1.

This position is located in Salisbury, Maryland (Wicomico County).  Are you willing to work in Wicomico County?
Yes No
2.
Do you possess a current LPN license from the Maryland Board of Nursing or one of the states in the Multi-State Licensure Compact Current Membership?
Yes No
3,

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

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