**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.
If yes, please provide your license number, expiration date and state (if it is a compact state). Not providing this information may result in disqualification. If you do not possess this license please write N/A.
3.
Do you have a Bachelor's degree in Nursing from an accredited college or university?
Yes
No
4.
Describe your experience as a Community Health Nurse. 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 supervisory experience. Please describe in detail your experience, including the name of your employers, dates of employment and hours worked per week in the box below. If you do not have this type of experience, please write N/A.
6.
Describe your school health nursing experience. 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 put N/A in the box below.
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