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#24-001086-0005
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.

Do you have a Bachelor's degree in Biochemistry, Biology, Biotechnology, Chemistry, Genetics, Immunology, Microbiology, Molecular Biology, Medical Technology, Pharmacology or Zoology from an accredited college or university?

Yes No
2.

Describe your experience working in a chemistry laboratory performing analytical tests on environmental, biological or multi-matrix samples.

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. 

3.

Describe your experience working in a medical or public health laboratory performing diagnostic or public health testing on human specimens.

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 working within a public health or clinical laboratory.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

5.

Describe your experience with Biological Safety Level (BSL)-2 and BSL-3 operations.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box.

6.

Describe your experience planning, organizing and coordinating work assignments.

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.

7.

Describe your experience utilizing a computer, including your experience with Microsoft Office Suite programs.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.


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