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#19-002430-0007
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

Describe your experience performing inspections and investigations to ensure compliance with environmental health laws and regulations.

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.

3

Describe your experience reviewing architectural plans for food service facilities.

Include name of employer, job title, dates employed, and hours worked per week for each position that demonstrates this experience.  If you do not have this experience, put N/A in the box below.

4

Describe your experience reviewing Hazard Analysis and Critical Control Points (HACCP) plans.

Include name of employer, job title, dates employed, and hours worked per week for each position that demonstrates this experience.  If you do not have this experience, put N/A in the box below.

5

Describe your experience performing preopening inspections of food service facilities.

Include name of employer, job title, dates employed, and hours worked per week for each position that demonstrates this experience.  If you do not have this experience, put N/A in the box below.

6

Describe your experience conducting mandated food service facility inspections.

Include name of employer, job title, dates employed, and hours worked per week for each position that demonstrates this experience.  If you do not have this experience, put N/A in the box below.


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