Official SealDepartment of Budget and Management


#19-000348-0001
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 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 in the box below.

3.

Describe your experience identifying "high risk" issues within a forensic hospital environment.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

4.

Describe your experience identifying, assessing and reducing risks that may impact the safety of patients, staff, visitors.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

5.

Describe your experience prioritizing needs to be corrected in order to promote high quality care (once risks are identified).

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

6.

Please describe your experience explaining information (written and verbally) to internal and external customers, and community partners. Please include name of employer, job title, dates of employment, and hours worked per week. This information must be reflected in your application. If you do not have this type of experience, please indicate N/A.


Powered by JobAps