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#17-005479-0024
Supplemental Questionnaire

Last Name
First Name

 

Please note that your answer on the supplemental questionnaire must correspond to the information that is provided on your resume to receive credit.


1

Do you possess a doctoral degree from an acredited academic institution in microbiology, molecular biology or related life science discipline?

Yes No
2

What field of study is your degree in?

3

Describe your experience supervising a CLIA compliant clinical laboratory.

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 biosafety 3 laboratory.

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

Do you possess medical clearance to wear a N95/PAPR respirator?

Yes No
6

Are you able to maintain immunization against the Rabies virus?

Yes No

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