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#23-001992-0005
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 position requires the applicant to be bilingual in Spanish/English.  The selected candidate must possess one (1) year of experience providing bilingual services for child and adolescent therapy.  Do you possess one year of experience providing bilingual services for child and adolescent therapy? If so, please describe this experience in the text box below.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

2

Do you currently possess a license as a Certified Social Worker (LCSW) or Certified Social Worker, Clinical (LCSW-C) by the Maryland State Board of Social Work Examiners?

Yes No
3

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

4

Please indicate the date that you earned your Master's degree in Social Work in the space below (i.e., May 2010). If you do not have a Master's degree in Social Work, put N/A in the space below.

5

Describe your professional work experience rendering clinical social work services in a health care or treatment setting subsequent to the receipt of an approved Master's degree in Social Work from an accredited college or university.

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 knowledge of and experience with play therapy and trauma-focused work.  Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must be reflected in your application.  If you do not possess this experience, put N/A in the box below.

7

Describe your experience working with youth and families.  Please include name of employer, job title, dates of employment, and hours worked for each relevant position.  This experience must be reflected in your application.  If you do not possess this experience, put N/A in the box below.


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