**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 Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?
Yes
No
2.
Please provide your license number and expiration date in the box below.
3.
Do you possess a Bachelor's degree in Nursing or a related field from an accredited college or university?
Yes
No
4.
In which field of study is your degree? If you do not have a degree, enter N/A.
5.
Do you possess a master's degree in nursing or a related field?
Yes
No
6.
What field of study is your master's degree in?
7.
Describe your medical/clinical nursing experience (as a registered nurse).
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 experience in a supervisory, teaching or administrative capacity.
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.
9.
Describe your experience with regulatory compliance to include OHCQ, CMS, CARF, and The Joint Commission Standards.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.
10.
Describe your experience writing/crafting policy and implementation.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.
11.
Describe your experience implementing and/or carrying out performance and quality improvement initiatives in a medical facility.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.
Department of Budget and Management