Official SealDepartment of Budget and Management

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.***


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?

Yes No

Please provide your license number and expiration date in the box below.


Do you possess a bachelor's degree in nursing or a related field?

Yes No

Do you possess a master's degree in nursing or a related field?

Yes No

Describe your experience as a Registered Nurse in a psychiatric setting, including dates and hours worked.


This position will work during Evening Shift 2, from 2:40 PM to 11:40 PM.  Are you willing to work this shift?

Yes No

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