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#21-001094-0002
Supplemental Questionnaire

Last Name
First Name

 

Please ensure your responses to the following supplemental questions are documented in the spaces provided for each question.  This includes dates of employment and employer information. Otherwise, you will not receive credit for the questions.


1
Do you possess a Bachelor’s Degree in Biochemistry, Biology, Biotechnology, Chemistry, Genetics, Immunology, Microbiology, Molecular Biology, Medical Technology, Pharmacy or Zoology from an accredited college or university, or will you receive the degree within three months?
Yes No
2

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. 

3

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. 

4

Describe your experience with serology testing.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

5

Describe your experience with automated laboratory instruments (i.e. Abbott Architect Analyzer and Hologic Panther System).

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.

6

Describe your experience with quality assurance and CLIA regulations.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.


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