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#19-004295-0001
Supplemental Questionnaire

Last Name
First Name

 

Below you will find supplemental questions relating to the education and experience that is required and/or preferred for this position.  The intent of the supplemental questionnaire is to provide applicants with the opportunity to elaborate on the specific education/experience possessed, as it pertains to duties of the position.  

Please provide a full answer to every question and refrain from indicating "See Resume".  Answers received on the supplemental questionnaire must correspond to the information provided on the resume, including name of employer, dates of employment, and hours worked per week. Any employment that is listed on the supplemental questionnaire but not included in the resume will not be credited. 

Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.


1

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
2

Please provide your license number and expiration date in the box below.

3

Do you possess a bachelor's degree in nursing or a related field?

Yes No
4

What field of study is your degree in?

5

Do you possess a master's degree in nursing or a related field?

Yes No
6

What field of study is your master's degree in?

7

Describe your experience as a Registered Nurse in a psychiatric setting, including dates and hours worked.

8

Describe your supervisory, teaching or administrative experience in nursing, including dates and hours worked. If none, enter "N/A".


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