**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
Are you currently licensed to practice medicine by the Maryland Board of Physicians? (If Yes, please submit a copy of your license or license verification with your application.)
Yes
No
2
If you answered yes, please attach a copy of your license to your application. Also, provide the license number and expiration date below.
3
Are you Board Certified in Psychiatry? Please submit a copy of your license with your application.
Yes
No
4
Describe your experience with a forensic population.
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 experience with participating in and/or leading committees.
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.
Department of Budget and Management