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#21-004220-0001
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

Describe your experience serving as a program manager and supervisor of large scale multi-faceted programs with associated projects to include monitoring metrics, quality control and performance indicators, and grant requirements.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

2

Describe your experience/ability to work in a fast-paced, ever changing environment while simultaneously overseeing multiple activities.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

3

Do you posses a current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement? Please provide your license number and expiration date in the box below.


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