Department of Budget and Management

**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.**

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.

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?

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

Describe your experience in risk assessment.

This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.

Describe your supervisory/leadership experience in a hospital setting.

This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.

Describe your experience writing Plans of Care (POC).

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.

Describe your knowledge of and experience with the Joint Commission and CMS standards.

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.