Official SealDepartment of Budget and Management


#19-004215-0009
Supplemental Questionnaire

Last Name
First Name
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 OR the date you will be sitting for the exam. Not providing this information may result in disqualification.
3.

The selected candidate should be available for summer school nursing coverage. Are you available to provide this coverage?
Yes No

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