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#20-004284-0040
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.

Please describe your experience using computers and any related computer software. If you do not have this experience, please indicate N/A.

4.

Please describe your experience completing multiple tasks in a busy work environment.  If you do not possess this type of experience, please indicate N/A in the text box below.


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