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#19-004216-0012
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

This recruitment is limited to current employees of the Anne Arundel County Department of Health.  Are you a current employee of the Anne Arundel County Department of Health?

Yes No
2

Do you possess a current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?

Yes No
3

Please provide your license number and expiration date OR the date you will be sitting for the exam. Not providing this information may result in disqualification.

4

Describe your experience providing health outreach activities to community groups, health care providers, and the business community.

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

Describe your experience with eligibility and enrollment activities for government health care programs and providing accurate information concerning services available to potential clients of these programs in response to public inquiries.

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.


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