***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 you responded Yes to question 1, please provide your license number and full expiration date in the box below. If your license is from a compact state, please provide a copy of your license or license verification. Enter N/A if this question does not apply to you.
3.
Please explain your experience providing medical services to a pediatric or adolescent population. Please include the dates of employment, name of the employer, job duties and hours worked per week. If you do not possess this experience, please write N/A.
Department of Budget and Management