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#20-004284-0012
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.

This position will require working either the evening shift (4:00 p.m. to 12:30 a.m.) or the night shift (12 a.m. to 8:30 a.m.)  No day shift positions are available.

Are you willing to work either evening or night shift?

Yes No

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