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#18-004425-0001
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.

Describe your experience installing, maintaining, testing and calibrating bio-medical telemetry, two-way radio, video or microwave systems. In your description, include the job duties performed, name(s) of employer(s) and dates of employment. If you do not possess this experience, please enter N/A.

2.

Do you possess a CISCO certification or have you received CISCO training? If yes, please indicate the type of certification or training. If no, please enter N/A.

3.

Do you currently possess a Federal Communications Commission General Radiotelephone license?

Yes No
4.

Please list in the box below any of the following certifications/licenses you have:  Federal Communications Commission General Radiotelephone license, or a certificate from the Association of Professional Communications Officers, Society of Broadcast Engineers, National Association of Radio and Telecommunications Engineers, or National Association of Business and Radio Engineers.  If you do not have this, please enter N/A.  (If you have this certification/license please upload a copy with your application.)


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