Official SealDepartment of Budget and Management


#17-004247-0015
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 LPN license from the Maryland Board of Nursing or one of the states in the Multi-State Licensure Compact Current Membership?
Yes No
3

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

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