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#18-000336-0002
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 possess an Associates of Arts degree in Mortuary Science from an accredited college or university?

Yes No
2.

If you answered "yes" to the previous question, please indicate the date that you earned your degree in the space below.  If you do not have a degree in the specified field, put N/A in the space below:

3.

Describe your experience embalming and assisting in the performance of autopsies on humans.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.

4.

Describe your experience assisting in the performance of autopsy examinations and lifting/moving human remains.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  This experience must also be reflected in the "Work Experience" section of your application.  If you do not have this experience, put N/A in the box below.


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