**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 two years of experience providing support services to children or adults through teaching and demonstrating practical living skills in order to promote and maintain independent living or assist in preserving the family structure?
Yes
No
2.
If yes, please include name of employer, job title, dates of employment, hours worked per week and specific job duties relating to the experience mentioned above. (This information should also be reflected on your application.)
If you do not possess experience in this area, put N/A in the box below.
3.
Do you possess a current license as a Certified Nursing Assistant (CNA) or a Geriatric Nursing Assistant (GNA) from the Maryland Board of Nursing?
Yes
No
4.
If yes, please provide your license type, license number and expiration date below.
Department of Budget and Management