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#20-001560-0001
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 have a minimum of an Associate's degree in a Health or Human Services counseling field OR an  Associate's degree in a program of study with a counseling emphasis AND 1 credit in Alcohol and Drug Ethics?  If yes, you must submit a copy of your transcripts documenting the completed coursework with your application.

Yes No
2
If you answered no to question #1, do you have an Associate's degree in another field plus 15 credits in the following:
 
- Pharmacology of Psychoactive Drugs
- Individual Counseling
- Group Counseling
- Abnormal Psychology
- Addictions treatment delivery
- Human Grown and Development
- Topics in Alcohol and Drug dependency
- Family Counseling
- Theories of Counseling
 
AND 1 credit or 15 CEU's in Ethics with a focus on alcohol and drug counseling?
 
If yes, please submit a copy of your transcripts (transcripts may be unofficial) documenting the completed coursework with your application.
Yes No
3

In accordance with Health Occupations Title 17 and Code of Maryland Regulations 10.58.07, candidates must apply for and receive a letter of authorization to practice as a trainee from the Board of Professional Counselors and Therapists within 90 days of their date of hire.  Do you possess a letter of authorization to practice as a trainee from the Board? If yes, please upload copy of letter with application.

Yes No
4

Describe your experience in which you used strong communication and interpersonal skills.

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 working in a high volume office with deadlines and handling multiple duties.

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.

6

Describe your analytical ability to gather and interpret data and communicate desired outcomes.

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.

7

The candidate selected for this position must be willing to work evenings, weekends and holidays. Are you willing to work evenings, weekends and holidays?

Yes No

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