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#20-000277-0002
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 Environmental Health Specialist from the Maryland State Board of Environmental Health Specialists? If you respond YES to this question, please upload a copy of your license to the application.

Yes No
2

Describe your environmental health work experience in the promotion, control, and maintenance of environmental health. 

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This information must also be reflected in your application.  If you do not have this experience, put N/A in the box below.

3

Describe your experience conducting public swimming pool inspections.

Include name of employer, job title, dates employed and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below. 

4

Describe your experience collaborating with industries, local governments and State and federal agencies.

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 providing training to members of the industry and members of the public.

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.


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