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#19-003642-0002
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 a Master's degree in the field of Public Health from an accredited college or university with a minimum of three graduate courses in Epidemiology and one graduate course in Biostatistics?

Yes No
2.

If yes, please list the required coursework (three graduate Epidemiology courses and one graduate course in Biostatistics) in the space below using the following format.  If no, please indicate N/A. You may also attach a copy of your official or unofficial transcripts to your application:

Example:  Course Number        Title                                    Credits Earned

                     EPI 101            Introduction to Epidemiology        3.0 

 

*This information will be verified upon employment.  

3.

When did you earn your master's degree (please indicate the month and year)?

4.

Do you have two years of experience in designing and conducting epidemiological studies and investigations for disease surveillance as an epidemiologist subsequent to receipt of your Master’s degree?

Yes No
5.

Describe your experience designing and conducting epidemiological studies and investigations for disease surveillance as an epidemiologist subsequent to the receipt of your Master's degree.

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below.

 

6.

Describe your experience in SAS and database management.

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.

7.

Describe your experience in public health preparedness and syndromic surveillance at the Federal and State level.

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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