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#18-000321-0002
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 current license as a Registered Environmental Health Specialist from the Maryland Board of Environmental Health Specialists? If you responded YES to this question, please upload a copy of your license to the application.

Yes No
2.

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.

3.

Describe your environmental health work experience in the promotion, control, and maintenance of environmental health. 

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This information must also be reflected in your application.  If you do not have this experience, put N/A in the box below.

4.

Describe your experience in environmental health work that involved direction of an environmental control project and/or the supervision of positions performing environmental health work.

With your description, please include name of employer, job title, titles of those you supervised (if applicable), dates of employment, and hours worked per week for each relevant position.  This information must also be reflected in your application.  If you do not have this experience, put N/A in the box below.

5.

Describe your experience conducting inspections of food processing plants.

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.

6.

Describe your professional experience using Excel and database report functions.

In your response include the types of reports and functions utilized.  Also 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.


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