Official SealDepartment of Budget and Management


#22-004608-0002
Supplemental Questionnaire

Last Name
First Name

 

Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.


1

Do you possess a degree in medicine from an accredited college or university?

Yes No
2

Are you currently licensed to practice medicine by the Maryland Board of Physicians?  (If Yes, please submit a copy of your license or license verification with your application.)

Yes No
3

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

4

Describe your experience as a licensed physician working in the field of public health.

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. 

5

Describe your experience at the managerial or supervisory level. Please include name of employer, job title, titles of those you supervised, programs managed, dates of employment, and hours worked per week.  This information must also be reflected in your application or resume. 

If you do not possess experience in this area, put N/A in the box below.

6

Describe your experience working with children and youth with special health care needs.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box.

7

Describe your project management experience, including experience developing and monitoring work plans and budgets.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.


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