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#17-001094-0004
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 in Biochemistry, Biology, Biotechnology, Chemistry, Genetics, Immunology, Microbiology, Molecular Biology, Medical Technology, Pharmacology or Zoology from an accredited college or university?

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.

Do you possess at least one course in biochemistry and one course in molecular biology/cell biology?  If yes, a copy of your transcripts (official or unofficial) must accompany your application in order to receive credit.  Failure to submit your transcripts may result in disqualification. 

Yes No
5.

Describe your experience performing molecular biology based assays, including nucleic acid sequencing.

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.

6.

Describe your experience performing testing at biosafety level 3 (BSL-3).

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.

Please describe your supervisory experience.  Include employer name(s), job title(s), dates of employment, and titles of those you supervised.  (If you do not possess this experience, enter N/A.)


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