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#19-000839-0001
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.

Are you a current employee of the Maryland State Board of Examiners of Nursing Home Administrators?

Yes No
2.

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

 

If yes, please submit a copy of your transcripts showing the required courework with your application.


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 at the supervisory or managerial level.

Please include name of employer, job title, title(s) of those you supervised or managed, number of employees supervised, 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 possess experience in this area, put N/A in the box below. 

5.

Describe your experience conducting investigations.

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 have this experience, put N/A in the box below.


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