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#22-000844-0003
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

Do you possess a bachelor's degree in the field of Criminal Justice, Criminology, Law Enforcement or an allied health (such as Nursing, Pharmacy, Psychology, Social Work, Nutrition, Dietetics, Speech Pathology, Audiology)?

Yes No
2

If you responded YES to the above question, what field is your Bachelor's degree in?

3

Describe your experience conducting criminal investigations, including the preparation of analyses and reports for use in legal proceedings.

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. 

4

Describe your experience working with a regulatory board.

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.

5

Describe your experience testifying in court or at formal hearings concerning investigations of licensee(s).

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

Please describe your experience leading or supervising employees. Please include the name of the employer(s) and dates of employment in which you obtained this experience. If you do not possess this experience, indicate N/A in the box below.

7

Describe your working knowledge of the laws and regulations of the State of Maryland, especially those governing health care providers in dentistry.

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.


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