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#22-003642-0016
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 possess a Master's degree in the field of Public Health, with a minimum of three courses in Epidemiology and one course in Biostatistics? If YES, please upload transcript(s). Unofficial versions of transcripts are accepted.

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

Do you have two years of experience in designing and conducting epidemiological studies and investigations for disease surveillance as an epidemiologist subsequent to receipt of your Master’s degree?

Yes No
4

Describe your experience designing and conducting epidemiological studies and investigations for disease surveillance as an epidemiologist subsequent to the receipt of your Master's degree.

Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below.

 

5

Describe your experience using SAS Analytics software.

This experience must be identified in the Work Experience section of the application, including dates and hours worked and a description of the job duties performed. If you do not possess this type of experience, please indicate N/A in the text box. 

6

Describe your experience managing a public health program.

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.


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