Official SealDepartment of Budget and Management


#19-004227-0002
Supplemental Questionnaire

Last Name
First Name
1.

Are you licensed as a dental assistant through the Maryland Board of Dental Examiners?  If yes, please submit a copy of your license with your application.
Yes No
2.

Do you possess a motor vehicle operator’s license valid in the State of Maryland?
Yes No
3.

Please describe your data entry experience in the box below.  Be sure to list job duties, dates and places of employment.  If you do not have this experience, enter N/A.

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