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#19-000716-0002
Supplemental Questionnaire

Last Name
First Name

 

Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.


1.

This recruitment is limited to current employees of the MDH Allegany County Health Department.  Are you a current employee of the MDH Allegany County HD?

Yes No
2.

Do you possess a Bachelor's degree from an accredited college or university?

Yes No
3.

If you responded YES to the above question, what field is your Bachelor's degree in?

4.

Describe your professional experience in health or human services administration. 

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.

Explain your professional work experience related to treatment and services to persons with alcohol or other substance abuse addiction.

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. 

6.

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. 

7.

Do you possess a current license as a Licensed Clinical Alcohol and Drug Counselor (LCADC) from the Maryland Board of Professional Counselors and Therapists? If yes, please upload a copy of your license with your application.

Yes No
8.

If you indicated YES to the above question, please include your license number and expiration date in the text box below.

9.

Do you possess a current Maryland license as a Maryland Clinical Professional Counselor (LCPC)? If yes, please attach a copy of your license with your application.

Yes No
10.

If you responded YES to the above question, please provide your license number and expiration date in the text box below.

11.

Are you currently a Certified Alcohol and Drug Approved Supervisor, certified by the Maryland Board of Professional Counselors and Therapists? If yes, please upload and attach a copy of your letter and certificate to your application.

Yes No

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