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#21-001005-0001
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 have a Bachelor's degree from an accredited college or university with a minimum of 30 credits in mathematical, physical or biological sciences? Please include your transcripts (unofficial okay).
Yes No
2.

Do you have five years of experience in performing the recognition, evaluation and control or radiological hazards? If you do not possess this experience, please enter N/A.
Yes No
3.

Do you have experience with supervising employees in a technical or regulatory setting?
Yes No

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