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#19-002432-0004
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

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.

2

Describe your supervisory experience.  Please describe in detail your experience, including the name of your employers, dates of employment and hours worked per week in the box below. If you do not have this type of experience, please write N/A.

3

Do you possess a current license as an Environmental Health Specialist issued by the Maryland Board of Environmental Health Specialists? 

Yes No
 

If you answered yes, please upload a copy of your license to the application or include license number and expiration date in box below.  If you do not possess this license, please indicate N/A.

4

Describe your experience planning, developing, implementing and evaluating an Environmental Health Program.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

5

Describe your experience conducting inspections for food service facilities and community protection programs.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.


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