**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.**
Do you have a current Certified Nursing Assistant license in Maryland?
Please provide your license number and expiration date in the box below.
Describe your work assisting in the care, treatment, habilitation or rehabilitation of developmentally disabled, mentally ill, physically ill or aged individuals in treatment facilities or community based programs. 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.
Please select the facilities where you are interested in working (you may select multiple locations). When completing your application please be sure to select the counties associated with the facility or department for which you have an interest in order to be considered:
|Clifton T. Perkins Hospital Center, Jessup, MD (Howard County) - Forensic psychiatric facility providing care to mentally ill offenders, patients and residents who have been judged NCR for committing felonies or are too violent for a regular hospital or residential setting.|
|Springfield Hospital Center, Sykesville, MD (Carroll County) - Regional psychiatric hospital providing a wide range of clinical services for treatment of patients with mental illness.|
|Spring Grove Hospital Center, Catonsville, MD (Baltimore County) - 375-bed complex providing a broad spectrum of inpatient psychiatric services to adults and adolescents, as well as comprehensive residential psychiatric services to adults.|
|RICA Baltimore, Baltimore, MD (Baltimore City) - Mental health residential treatment facility that serves adolescents and their families by providing treatment through a qualified multidisciplinary treatment team and educational programs for adolescents experiencing emitonal, behavioral and learning difficulties.|
|RICA Rockville, Rockville, MD (Montgomery County) - A community-based public residential, clinical and educational facility serving children and adolescents with severe emotional disabilities.|
|Deer's Head Hospital Center, Salisbury, MD (Wicomico County) - State facility providing outcome oriented, comprehensive management of complex medical conditions. A variety of services a provided within the specialy hospital, inpatient and outpatient dialysis units, and in skilled/long-term care.|
|Eastern Shore Hospital Center, Cambridge, MD (Dorchester County) - Mental health facility with 4 psychiatric units with a total of 80 beds. Provides inpatient mental health services for adults 18 and older.|
|Holly Center, Salisbury, MD (Wicomico County) - State residential center that provides needed services to people who have intellectual disabilities that are working to be integrated into less restrictive settings in the community. This facility is operated by the Developmental Disabilities Administration.|
|Potomac Center, Hagerstown, MD (Washington County) - State residential center that provides needed services to people who have intellectual disabilities that are working to be integrated into less restrictive settings in the community. This facility is operated by the Developmental Disabilities Administration.|
|SETT/Court Involved Residential Program (CIRP), Hagerstown, MD (Washington County) - Provides evaluation and assessment services, as well as active treatment to people with intellectual disabilities and court involvement within a secure and safe environment.|
|Thomas B. Finan Center, Cumberland, MD (Allegany County) - A multi-purpose, inpatient psychiatric facility operating 88 beds. This facility provides specialized evaluation and treatment services for adult and geriatric psychiatric patients.|
|Western Maryland Hospital Center, Hagerstown, MD (Washington County) - A specialized health care center delivering compassionate rehabilitation to clinically complex individuals in a therapeutic environment.|
|Allegany County Health Department, Cumberland, MD (Allegany County) - The Allegany County Health Department runs a 24/7 inpatient addiction treatment unit (Joseph S. Massey Unit) and has a Behavioral Health Unit.|
|Kent County Health Department, Chestertown, MD (Kent County) - Kent County Health Department runs the A.F. Whitsitt Center which is a 24/7 residential treatment facility offering treatment to adults ages 18 and over suffering from chemical dependency and co-occurring disorders.|
|Office of the Chief Medical Examiner (OCME), Baltimore, MD (Baltimore City) - OCME is the statewide agency designated by law to investigate deaths from injury, homicide, suicide, under unusual or suspicious circumstances, or when a person is not attended by a physician. OCME also serves a critical public health role by identifying injury trends or potential infectious diseases that may pose risk to Marylanders.|