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#21-002430-0004
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 Environmental Health Specialist from the Maryland Board of Environmental Health Specialists? If you responded YES to this question, please upload a copy of your license to the application.

Yes No
2.

If yes, please provide your license type, license number and expiration date below.

3.

Describe your experience performing inspections and investigations to ensure compliance with environmental health laws and regulations. 

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

4.

Describe your experience conducting environmental health inspections.

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.

5.

Describe your experience investigating complaints and/or outbreaks within an environmental health program and/or facility.

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.

 


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