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Human Capital Management
#191009-X14B-02


Supplemental Questionnaire

Last Name First Name
 
1.

What experience do you have receiving, sorting, and accessioning specimens/samples to appropriate laboratories?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
2.

What experience do you have determining acceptability of specimens/samples prior to laboratory testing?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
3.

What experience do you have in performing laboratory procedures related to the analysis of human, animal, microbiological, environmental, or other specimens/samples?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
4.

What experience do you have in performing laboratory quality control procedures and preparing and maintaining quality control materials to be used in laboratory testing?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
5.

What experience do you have in interpreting laboratory tests in the context of controls and calibrators, identifying problems, and performing troubleshooting?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
6.

What experience do you have with laboratory informational systems that document information relating to specimen/sample collection, identification, preservation, processing, quality control, reporting, and referral?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
7.

What experience do you have performing maintenance and function checks on electronic or mechanical equipment?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
8.

What experience do you have following all safety procedures and/or maintaining safety equipment?

I have supervised others performing this task.
I have performed this task independently.
I have performed this task under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.