Official SealDepartment of Budget and Management


#17-004284-0025
Supplemental Questionnaire

Last Name
First Name
1

This position will require working either the evening shift (4:00 p.m. to 12:30 a.m.) or the night shift (12 a.m. to 8:30 a.m.)  No day shift positions are available.

Are you willing to work either evening or night shift?

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 OR will you be sitting for the licensing exam within the next 90 days?

Yes No
3

Please provide your license number, expiration date and state (if it is a compact state) OR the date you will be sitting for the exam. Not providing this information may result in disqualification.


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