**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
Describe your experience as a Licensed Practical Nurse.
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.
2
Do you possess a current license as a Licensed Practical Nurse (LPN) from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement OR will you be sitting for the licensing exam within the next 90 days?
Yes
No
3
If yes, please provide your license type, license number and expiration date below.
4
Describe your experience with quality improvement projects that foster quality patient care and maintaining accurate patients records.
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 your experience with performing nursing procedures such as medication administration and medical treatment such as suctioning, catheterizations and application of dressings.
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 your experience with communicating changes in patients behaviors or health status to nurses, physicians and family members.
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.
Department of Budget and Management