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#17-003641-0013
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.***


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 with a National Electronic Disease Surveillance System (NEDSS)-compliant public health database.

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.

Describe your experience with Electronic Laboratory Reporting (ELR)-related functions.

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 knowledge and experience with common laboratory tests used in the diagnosis of reportable infectious diseases. 

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.

In the box below please describe your experience and level of profeciency with Microsoft Excel and Access.  If you do not have experience with Excel or Access, please enter N/A.


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