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#19-002428-0001
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 certificate of eligibility to be licensed as a Registered Environmental Health Specialist from the Maryland Board of Environmental Health Specialists?  A copy of your certificate must be attached to your application. 

Yes No
2.

If you answered Yes to the above question, please provide your license number and expiration date in the space below.  If you do not possess a certificate of eligibility, please indicate N/A in the text box below.

3.

Describe in 1-3 paragraphs your experience with food safety.

Do not copy and paste from your resume. 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.

4.

Much of environmental health is driven through regulatory activities.  An effective approach to enforcing regulations is through education. Describe in 1-3 paragraph your experience in educating a group of individuals on the importance and reason on regulations or other similar information.

Do not copy and paste from your resume. 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.

If you had to rate yourself on a scale from 1 to 5 with 1 being the lowest and 5 being the highest, how would you rate your ability to perform the duty in question #4?

1
2
3
4
5
6.

Do you possess a bachelor's degree from an accredited college or university in a science such as chemistry, physics, biology, soil science, geology, environmental science, environmental health or related field? If Yes, please list what your baccalaureate degree is below. If you do not possess a degree in any of the subjects listed, please indicate N/A in the text box below.


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