Official SealDepartment of Budget and Management


#26-004609-0001
Supplemental Questionnaire

Last Name
First Name

 

Qualified candidates must meet one of the the following criteria.

(1) (i) Be a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy in the State of Maryland; and (ii) Be certified in anatomic or clinical pathology, or both, by the American Board of Pathology or the American Osteopathic Board of Pathology; or
 
(2) (i) Be a doctor of medicine, a doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State of Maryland; and (ii) Have at least 2 years of experience directing or supervising high complexity testing; and (iii) Have at least 20 CE credit hours in laboratory practice that cover the director responsibilities defined in § 493.1445

1

Are you a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State of Maryland?

Yes No
2

Are you certified in anatomic or clinical pathology, or both, by the American Board of Pathology or the American Osteopathic Board of Pathology?

Yes No
3

Do you have two years of experience directing or supervising high complexity testing?

Yes No
4

Do you possess at least 20 CE credit hours in laboratory practice that cover the director responsibilities defined in §493.1445?

Yes No
5

Are you licensed by the Maryland Board of Physicians to practice medicine under Maryland State law? If so, please upload a copy of your current MD medical license to the application, or include your license # and expiration date in the text box below.


 

REMINDERS:

  • UPLOAD ALL PERTINENT DOCUMENTATION TO THE APPLICATION BEFORE SUBMISSION (i.e. Licenses, Certifications, Transcripts)
  • CLEARLY INDICATE LICENSE/CERTIFICATION NUMBERS AND EXPIRATION DATES ON THE APPLICATION


Powered by JobAps