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#19-000277-0006
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.***


1

Do you possess a current license as a Registered Environmental Health Specialist from the Maryland State Board of Environmental Health Specialists? If you respond YES to this question, please upload a copy of your license to the application.

Yes No
2

Describe your experience inspecting food facilities as well as experience communicating with supervisors of food establishments.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.


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