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#18-5149-01
Supplemental Questionnaire

Last Name
First Name
 

Thank you for your interest in the Chief Forensic Pathologist recruitment, Examination #18-5149-01. Applicants for this position are required to submit responses to the following supplemental questions. Your completed responses to the supplemental questionnaire will be evaluated to determine your qualifications and must be completed properly in order to be given full consideration for the next phase in the selection process and to further verify minimum qualifications. 

Responses should be thorough and specific. A resume will not be accepted as a substitute for properly completed responses. Information provided in your responses to the supplemental questionnaire regarding your employment experiences must also be detailed in the "Work Experience" section of the application for this recruitment.  Conflicting information may be cause for dismissal from advancement in the selection process.

By selecting "yes" below, you certify your understanding that all applicants must meet minimum qualifications in order to move forward in the process.  Do you understand the above statement?
Yes No
1.

Do you possess a M.D. or D.O. degree conferred by an accredited medical school?
Yes No
 

If you answered "Yes," please provide the name of the school and address where your M.D. or D.O. degree was obtained and the time period when you were enrolled. Note: You may be required to provide transcripts prior to
an offer of employment.
2.

Do you have the equivalent of two years' full-time post forensic residency/fellowship work experience in forensic pathology?
Yes No
 

If you answered "Yes," please provide the dates and where you completed your two years' full-time post forensic residency/fellowship work experience in forensic pathology.
3.

Have you completed a recognized residency program leading to board certification in forensic pathology and are you in possession of board certification in forensic pathology by the American Board of Pathology?
Yes No
4.

Do you possess a valid license to practice medicine or osteopathy in the State of California?
Yes No
 

If you answered "Yes," what is the license number?

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