**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 doctorate degree in psychology?
Yes
No
2.
Do you have one year of supervised experience rendering direct psychological services, providing psychological assessments, and evaluating the delivery of psychological services? If yes, please describe your experience below.
Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position. If you do not have this experience, put N/A in the box below.
3.
By checking yes to the box below, I hereby certify that I read and fully understand the items listed below and that I am willing to conform to these terms and conditions of employment as a Maryland Department of Health employee.
In accordance with the Health Occupations Article, Title 18-301 (b4), employees in this classification are required at the time of hire to apply jointly with the supervising Psychologist to the State Board of Examiners of Psychologists for an exemption from licensure. The exemption must be received within six months of submitting the application.
Candidates for this classification may be given a medical examination to determine their ability to perform job related functions.
Employees in this classification must be licensed as a Psychologist by the Maryland Board of Examiners of Psychologists within three years of appointment to a position.
Yes
No
4.
Describe your experience with psychiatric patients/residents.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
5.
Describe your experience with personality, intelligence, interest and aptitude measurements.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
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