Department of Budget and Management

**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.**

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?

Please provide your license number and expiration date in the box below.

Do you possess a certification in Infection Control (CIC)? If yes, please upload copy of certification to the application.

Do you possess a bachelor's degree in nursing or a related field?

Do you possess a master's degree in nursing or a related field?

Please describe your experience as a Registered Nurse in an administrative, supervisory, consultative or teaching capacity. 

Please include name of employer, job title, dates of employment, and hours worked per week. If you do not possess experience in this area, put N/A in the box below. 

Describe your experience as a Registered Nurse in a psychiatric setting.  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 this type of experience, indicate N/A in the box below.

Describe your leadership and management in infection prevention and control, which supervises other people for Infection Control Risk Assessments, performance improvement initiatives, environmental rounds, The Joint Commission surveys, CMS surveys in a hospital setting.

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.

Describe your experience applying clinical knowledge related to health acquired infections, antibiotic stewardship, clinical patient care associated with infection prevention and control and applying current CDC guidelines and OSHA standards on infection prevention, with a variety of employee health initiatives, coordination and implementation of immunization.

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.

Describe your experience writing and revising infection prevention and control policies and procedures.

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.

Describe your experience analyzing and reporting (verbal and written reports) data for quarterly, monthly and annual reports and actively participating/collaborating in hospital committees.

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.

Describe your experience applying current evidence-based practice as related to infection prevention and control and the ability to conduct interactive training and education on infection prevention and control topics in the behavioral health setting with both patients and employees of all educational levels.

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.

Describe your experience typing and utilizing MS Office and Google Applications (docs, sheets, slides).

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.