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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.**



Do you possess a current license as a Registered Environmental Health Specialist from the Maryland Board of Environmental Health Specialists? If you responded YES to this question, please upload a copy of your license to the application.

Yes No

If you responded YES to the above question, please provide your license number and expiration date in the text box below.


Describe your experience performing inspections and investigations to ensure compliance with environmental health laws and regulations. 

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

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