***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 possesss a current certificate as a Nurse Practitioner, Psychiatric from the Maryland State Board of Nursing?
Yes
No
2
If you answered Yes to the above question, please provide your license number and expiration date in the space below. If you do not possess a certificate of eligibility, please indicate N/A in the text box below.
3
Are you willing to work and travel to all sites of Worcester County Health Department?