**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 degree in medicine from an accredited college or university?
Yes
No
2.
Are you currently licensed to practice medicine by the Maryland Board of Physicians? (If Yes, please submit a copy of your license or license verification with your application.)
Yes
No
3.
This position requires that you possess a Board Certification. Please indicate the field in which you have your Board Certification.
4.
Describe your clinical experience.
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.
5.
Describe your leadership and management experience.
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.
Department of Budget and Management