Official SealDepartment of Budget and Management


#21-005479-0005
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 Bachelor's degree from an accredited college or university?

Yes No
2.

Do you possess a Master's Degree from an accredited college or university?

Yes No
3.

Describe your managerial experience in the field of health care, public health, human services or related field.

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.

4.

Describe your experience in the Long Term Care field. 

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 in a Continuing Care Retirement Community (CCRC).

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.

6.

Describe your experience managing a large unit.  Please include the number of employees managed in your response.  

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. 

7.

Describe your leadership experience.

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.

8.

Describe your knowledge of and/or experience with Nursing Home Regulations (i.e., CMS, COMAR, TJC, OHCQ) and the interpretation and application of regulatory requirements/standards.

This experience must also be included on your application (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 indicate N/A.

9.

Describe your experience with regulatory oversight.  

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. 


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