Official SealDepartment of Budget and Management


#21-002003-0007
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

Are you currently licensed as an LCSW-C or LMSW in Maryland? If not, please list when you anticipate being eligible for licensure and what requirements are still outstanding.

2

Describe your work experience providing forensic social work services.

3

Describe your experience conducting screening interviews and assessments and developing treatment plans.

4

List which grant population(s)/issue(s) you are particularly interested in working with: substance abuse, mental health, reentry of long sentence servers, parents in abuse/neglect proceedings, youth charged as adults, other (please specify); and describe any prior experience working with that population(s).


Powered by JobAps