Official SealDepartment of Budget and Management

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


 Do you have at least two years of experience as a trainer/instructor of
Police and/or Correctional Officers, developing and delivering training?

Yes No

If you answered yes please describe your experience in detail. Include names of employers and dates of employment. If you do not have this experience, please enter N/A.


Do you have a valid Academic Instructor Certification and Defensive Tactics Instructor Certification under COMAR 12.04.06 or 12.10.06 or are you able to achieve such certification within six months of beginning employment? [] Yes - Current [] Yes - within 6 months [] No

Yes No

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