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#17-004216-0017
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 credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1.

Are you a current employee of the Cecil County Health Department?

Yes No
2.

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
3.

Please provide your license number and expiration date in the box below.

4.

Describe your experience in the field of public health.

Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below. 

5.

Describe your experience working with children and/or families.

With your description, 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.

6.

Do you possess a current CPR certificate?

Yes No

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