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#19-002430-0005
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 current license as a Registered Environmental Health Specialist from the Maryland Board of Environmental Health Specialists? If you responded YES to this question, please upload a copy of your license to the application.

Yes No
2.

Describe in 1-3 paragraph(s) your experience performing food service facility inspections.

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.


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