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#19-005482-0019
Supplemental Questionnaire

Last Name
First Name

 

Below you will find supplemental questions relating to the education and experience that is required and/or preferred for this position.  The intent of the supplemental questionnaire is to provide applicants with the opportunity to elaborate on the specific education/experience possessed, as it pertains to duties of the position.  

Please provide a full answer to every question and refrain from indicating "See Resume".  Answers received on the supplemental questionnaire must correspond to the information provided on the resume, including name of employer, dates of employment, and hours worked per week. Any employment that is listed on the supplemental questionnaire but not included in the resume will not be credited. 

Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.


1

Are you licensed as a Psychologist from the Maryland Board of Examiners of Psychologists?  (If you respond Yes, please upload a copy with your application)

Yes No
2

If you answered Yes to question 1, please provide your license number and expiration date in the box below.  If No, please enter N/A in the box below.

3

Describe your experience conducting forensic evaluations or overseeing services to individuals within a criminal justice or court-ordered service delivery system of care. 

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 responsibility for development of protocols, policies or standard related to the service delivery system.

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.

5

Describe your experience at the supervisory or managerial level.

Please include name of employer, job title, dates of employment, and hours worked per week. If you do not possess experience in this area, put N/A in the box below. 


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