Department of Budget and Management

**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 experience assisting in the care, treatment, habilitation or rehabilitation of mentally or physically ill patients, aged or developmentally disabled 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.

Describe your professional experience providing personal care (i.e., toileting, meals, exercise) to elderly and/or disabled clients.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box.

Describe your experience transporting elderly and/or disabled clients to and from medical appointments.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box.