Official SealDepartment of Budget and Management


#18-000503-0003
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid CNA (Certified Nursing Assistant) or GNA (Geriatric Nursing Assistant) Certification from the Maryland Board of Nursing?

Yes No
2.

If yes, please include the license/certification number and expiration date of the license/certification.

3.

Do you possess nine college credits from an accredited college or university in a human service program or human development program such as child development, sociology, social work, psychology, counseling, nursing, criminology, juvenile justice, human growth and development, human services, or mental health?  If yes, please list courses and number of credits in each.  If no, indicate N/A.

4.

Please explain in detail, your experience maintaining records. Please include the name of your employer, job title, job duties, dates of employment, and hours worked per week. If you do not have this type of experience, please write N/A.

5.

Please explain in detail, your experience assigning, reviewing, delegating tasks. Please include the name of your employer, job title, job duties, dates of employment, and hours worked per week. If you do not have this type of experience, please indicate N/A.

6.

Please explain in detail, your administrative experience in an office setting. Please include the name of your employer, job title, job duties, dates of employment, and hours worked per week. If you do not have this type of experience, please indicate N/A.


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