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#18-000661-0003
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. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1.

Do you possess a Bachelor's degree from an accredited college or university including 30 credits in engineering, or the biological, environmental or physical sciences?

Yes No
2.
If yes, please list the required coursework (thirty credit hours in engineering, or biological, environmental, or physical sciences) in the space below using the following format.  If no, please indicate N/A. You must also attach a copy of your official or unofficial transcripts to your application:
 
Example:  Course Number   Title                                    Credits Earned
                   BIO 101            Introduction to Biology                  3.0 
 
*This information will be verified upon employment.  
3.

Describe your experience supervising a professional staff or as a project supervisor in the field of environmental health.

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.

4.

Do you possess a current license as an Environmental Health Specialist issued by the Maryland Board of Environmental Health Specialists? 

Yes No
5.

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

6.

Describe your experience reviewing architectural plans, HACCP plans and process for retail and manufacturing facilities.

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.

7.

Describe your ability to deal with and work collaboratively with state, local and federal agencies, legislators, developers for new food businesses, constituents and stakeholders in the food industry.

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.

8.

Describe your ability to navigate and interpret state and federal regulations, policies, and recommendations.

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.


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