**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 Pharmacist from the Maryland State Board of Pharmacy?
Yes
No
2
If you answered "yes", please provide your license number and expiration date below. You may also submit a copy of your license or license verification with your application.
3
Describe your clinical pharmacy experience as a Registered Pharmacist.
Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position. This experience must be reflected on your application. If you do not have experience in this area, put N/A in the box below.
4
Describe your knowledge of and experience with Maryland and federal statutes, regulations and policies that regulate the prescribing, dispensing, administering, distributing and manufacturing of controlled dangerous substances (CDS) and prescription drugs.
With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position. This experience must also be reflected in the "Work Experience" section of your application. If you do not have this experience, put N/A in the box below.
5
Describe your experience with the current practices in the field of pharmacy and medicine, including pharmacology, pharmaceutics, pharmacognocy, toxicology and clinical therapeutics.
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.
6
Describe your experience conducting inspections and investigations of OCSA registered practitioners, establishments and researchers for compliance with State and Federal CDS statutes and regulations, as well as, for diversion of CDS and CDS prescribed and dispensed for non-legitimate medical purposes.
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.
7
The employee assigned to this position will be required to travel. Do you possess a Motor Vehicle Operators License valid in the State of Maryland?
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