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#22-5149-01
Supplemental Questionnaire

Last Name
First Name

 

Thank you for your interest in the position of Chief Forensic Pathologist, Examination #22-5149-01.  Applicants for this position are required to submit responses to the following supplemental questions.  Your completed responses to the supplemental questionnaire will be evaluated to further verify minimum qualifications.  Failure to answer these questions truthfully may result in disqualification from the examination process.
1.

Do you possess a M.D. or D.O. degree conferred by an accredited medical school?
Yes No
 

If you selected "yes," please provide the name of the school and address where your M.D. or D.O. degree was obtained and the time period when you were enrolled.

Note:  You may be required to provide transcripts prior to an offer of employment.
2.

Do you possess the equivalent of two years full-time post forensic residency/fellowship work experience in forensic pathology?
Yes No
3.

Have you completed a recognized residency program leading to board certification in forensic pathology and are you in possession of board certification in forensic pathology by the American Board of Pathology?
Yes No
4.

Do you possess a license to practice medicine or osteopathy in the State of California?
Yes No
 

If you answered "yes," please provide your license number.

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