Official SealDepartment of Budget and Management


#18-004284-0011
Supplemental Questionnaire

Last Name
First Name
1

Are you able to work part-time?
Yes No
2

Do you possess a current license as a Registered Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement OR will you be sitting for the licensing exam within the next 90 days?
Yes No
3

Please provide your license number, expiration date and state (if it is a compact state) OR the date you will be sitting for the exam. Not providing this information may result in disqualification.

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