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#20-003643-0003
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.

Describe your experience as an epidemiologist.

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.

5.

Describe your experience with a health data system (electronic medical records, public health surveillance, laboratory information management system, etc) and managing interconnectivity of that system with other systems.

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 experience with messaging standards (e.g., HL7 messaging).

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 working in statistical analysis and visualization environments (e.g., SPSS, R, Stata, SAS, Tableau, PowerBi, R Shiny, ArcGIS, etc.)

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.

8.

Describe your experience working in public health at the federal, state or local level and in a high pressure setting with time-sensitive demands.

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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