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#17-000213-0008
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.***


1.

Do you possess a current certification as a Peer Recovery Specialist from the Maryland Addictions Professionals Certification Board (MAPCB)?  If so please attach a copy with your application.

Yes No
2.

Can you document that you have been in a state of recovery for 2 years from a substance use, mental health or co-occuring disorder?

Yes No
3.

Describe your experience with HIPPA, Code of Maryland Regulations (COMAR) and confidentiality laws and policies.

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.

4.

Describe your experience supporting clients/patients in a Mental Health or Addiction setting.

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.

5.

Describe your experience with managing multiple priorities in a fast-paced, goals/solutions oriented work environment.

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.

6.

Describe your experience utilizing Microsoft Access and/or Excel.


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