**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
Describe your professional experience in health services. Health services is defined as experience in areas other than Mental Health, Developmental Disabilities or Addictions.
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.
2
Describe your professional experience working in a health department and/or clinical 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.
3
Describe your professional work experience with communicable disease prevention and/or outreach, preferably in Sexually Transmitted Infections (STI's) and/or HIV.
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.
4
Please describe your experience working with the public. Include in your response employer name(s) and dates of employment. If you do not have this experience, indicate N/A.
5
Describe your knowledge of and/or experience with public health surveillance databases (i.e., NEDSS, STI/HIV NBS, MAVEN, PRISM, Salesforce).
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.
6
Describe your experience with medical records and interpreting laboratory reports.
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.
7
Describe your experience working with the LBGTQIA community.
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.
8
Describe your experience working with unstable housing populations, people with criminal justice involvement, adolescents, and/or people actively engaging in substance use.
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.
9
Do you possess certification in Phlebotomy? If you respond YES to this question, please upload a copy of your certification to this application.
Yes
No
10
If you are not actively certified in and practicing phlebotomy, would you be willing to become certified and perform field phlebotomy?
Yes
No
11
This position will be required to travel to multiple sites throughout Maryland in order to conduct field work. Are you willing to travel and if so, do you possess a driver's license valid in the State of Maryland?
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