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#21-004218-0028
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 Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?

Yes No
2.

Please provide your license number and expiration date in the box below.

3.

Describe in 1-3 paragraph(s), your experience with infection control management in healthcare facilities.

Do not copy and paste from your resume. 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.

 

4.

Describe in 1-3 paragraph(s), your experience leading a team and/or interest in gaining leadership skills.

Do not copy and paste from your resume. 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.

Describe in 1-3 paragraph(s), your extensive experience and knowledge using Microsoft Word, Excel, PowerPoint and Outlook.

Do not copy and paste from your resume. 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 in 1-3 paragraph(s), your experience and familiarity with OneDrive, Skype for Business, Microsoft Teams and WebEx.

Do not copy and paste from your resume. 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.


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