Official SealDepartment of Budget and Management


#19-001005-0001
Supplemental Questionnaire

Last Name
First Name
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 supervising employees in a technical or regulatory setting?
Yes No
4

Are you a certified Health Physicist? Yes _______ No _______ If yes, please provide (upload or email) documentation with your application to verify certification.
Yes No
5

Are you an authorized Medical Physicist or Radiation Safety Officer on a Federal or State Nuclear Material License? Yes _______ No _______ If yes, please provide (upload or email) documentation with your application to verify license
Yes No

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