**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 Nurse from the Maryland State Board of Nursing, or a license recognized by the Multi-State Compact agreement?
Yes
No
2.
Please provide your license number and expiration date in the box below.
3.
Do you possess a master's degree in nursing or a related field?
Yes
No
4.
Describe your experience in health services, healthcare administration, or your professional experience.
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 working at the executive level of management.
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.
6.
Do you possess any of the following advanced certifications? Please select the options that apply to you. A copy of your certification must be presented at time of interview.
Fellow of the American College of Healthcare Executives (FACHE)
I do not have any of the above certifications but I am willing to obtain at least one within 18 months of being hired.
I do not have any of the above certifications and I am not willing to obtain one within 18 months of being hired.
7.
Describe your management level experience. Management level experience is defined as program development, implementation and evaluation including supervision of subordinate supervisors and program staff.
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