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#18-000475-0003
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.***


1.

Please describe your experience in the repair and maintenance of gasoline or diesel-powered motor vehicles.  Please include dates, place of employment and number of hours worked per week.  This experience must also be reflected in your application to receive credit.  If no experience, indicate N/A.

2.

Please describe your experience in the inspection of gasoline or diesel-powered motor vehicles for the purpose of ensuring their safe operating condition.  Please include dates, place of employment and number of hours worked per week.  This information must be reflected in your application to receive credit.  If no experience, indicate N/A.

3.

Have you completed a Maryland State Police approved course in North American Standard Commercial Vehicle Inspection (Part A and Part B) and have maintained compliance with established certification requirements for at least one year?

Yes No
4.

If you answered yes to the question above, please indicate when you took the approved courses in North American Standard Commercial Vehicle Inspection (Part A and Part B). If you answered no, please enter N/A.

5.

Do you currently possess an American Vehicle Standard Passenger Vehicle Inspection Certification?

Yes No

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