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#24-004216-0014
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. You must possess both the minimum and selective qualification to be approved for this recruitment.*** 


1.

Do you possess an active Registered Nurse licensure from the Maryland State Board of Nursing? 

Yes No
2.

Do you possess one year of supervisory experience in a nursing home or hospital?

Yes No
 

If yes, please include name of employer, job title, dates of employment, hours worked per week and SPECIFIC JOB DUTIES relating to this experience below. 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.

3.

Do you possess one year of experience as a home health nurse? 

Yes No
 

If yes, please include name of employer, job title, dates of employment, hours worked per week and SPECIFIC JOB DUTIES relating to this experience below. This information must also be reflected in your application.  If you do not possess this experience, write n/a.

4.

 Do you possess one year of experience using Microsoft office and Google Suite?

Yes No
 

If yes, please include name of employer, job title, dates of employment, hours worked per week and SPECIFIC JOB DUTIES relating to this experience below. 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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