**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 current Certified Nursing Assistant license in Maryland?
Yes
No
2
Please provide your license number and expiration date in the box below.
3
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.
4
Describe your experience working with the forensic/court-involved population.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
5
Describe your experience assisting with activities of daily living and active treatment.
This experience should be included on your application. If you do not possess this type of experience, please put N/A in the text box.
Department of Budget and Management