Official SealDepartment of Budget and Management


#22-000351-0003
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

Please explain your experience as a Registered Nurse in a supervisory, administrative or consultative capacity. Please include the employer(s) names, dates of employment, job duties and hours worked per week. If you do not have this experience, please write N/A.

2

Please describe your experience working as a Registered Nurse in a Psychiatric setting.  Include dates and hours worked per week.  If you do not possess experience in this area, put N/A in the box below.

3

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
4

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

5

This position will require you to work weekends and holidays.  Please indicate that you agree to and understand this job requirement.

Yes No

Powered by JobAps