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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?  Please upload a copy of your license to the application. 

Yes No

If you answered Yes to the above question, please provide your license number and expiration date in the space below.  If you do not possess a certificate of eligibility, please indicate N/A 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.


Describe your experience with septic design review, evaluation and inspection.

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 with communication, both oral and written. Include what type(s) of audience(s) with whom you communicate.

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