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#22-000479-0003
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

This recruitment is limited to current employees of the MDH Behavioral Health Administration's Clinical Services Division only. Are you a current employee of the MDH BHA Clinical Services Division?

Yes No
2

Do you possess a Bachelor's degree in Nursing, Social Work, Psychology, Education, Counseling or a related field?

Yes No
3

What is the major field of study for your bachelor's degree? If you answered "No" to the previous question, please enter N/A in the box.

4

Describe your professional health services experience.

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 professional experience related to the treatment and services for mentally ill patients. 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.

6

Describe your professional experience with the Public Behavioral Health System (PBHS). 

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.

7

Describe your experience working with an Assertive Community Treatment or Supported Employment Team.

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.

8

Do you possess a Maryland license in Nursing, Counseling or Social Work? If you do, please specify the license you possess, the license number and expiration date in the text box. If you do not possess a license, indicate N/A.

9

This position requires travel throughout the State of Maryland. Are you willing to meet this requirement?

Yes No

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