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#19-001096-0001
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. 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 Biochemistry, Biology, Biotechnology, Chemistry, Genetics, Immunology, Microbiology, Molecular Biology, Medical Technology, Pharmacy or Zoology from an accredited college or university?

Yes No
2.

What field of study is your master's degree in?

3.

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. 

4.

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. 

5.

Describe your experience handling potentially infectious pathogens.

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. 

6.

Describe your knowledge of and/or experience with the principles of anti-microbial resistance testing.

This experience must also be included on your application (please include name of employer, job title, dates of employment and hours worked per week). If you do not possess this type of experience, please indicate N/A.

7.

Describe your experience working in biosafety level  II and III laboratories.

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.


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