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Human Capital Management
#210503-X13B-01


Supplemental Questionnaire

Last Name First Name
 
 

Do you have any of the following?

one year of experience in laboratory work performing laboratory procedures
two (2) college-level laboratory science courses
an equivalent combination of experience, substituting one college-level laboratory science course for each six months of required experience
none of the above

 

ATTENTION!

 Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire. The questions below will be used for scoring purposes, in lieu of a written exam.


 

What experience do you have performing routine laboratory procedures such as preparing analytical smears?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have conducting routine laboratory tests and procedures without the use of analytical instruments?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have setting up and operating laboratory equipment in preparation for specimen examinations?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have receiving, logging and organizing samples in preparation for analysis?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

 

What experience do you have maintaining simple laboratory records and inventory for supplies and reagents?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have maintaining laboratory equipment by cleaning it and maintaining quality assurance records?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have maintaining a clean and safe work area in accordance with standard laboratory practices and procedures?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have performed this task under supervision as a regular part of my job.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have using pipettes?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have organizing and maintaining files?

I have performed this task independently as a regular part of my job.
I have performed this task under supervision as a regular part of my job.
I have had classes or training on this task.
I have no experience with this task.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

What experience do you have assisting customers over the telephone?

I have performed this task independently as a regular part of my job.
Performing this task was a minor part of my job duties.
I have no experience with this task.
 
Please list the employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 
 

Please check all of the following analytical equipment you have experience using.

High Performance Liquid Chromatography (HPLC)
Gas Chromatography (GC)
Automatic extraction apparatuses
Internally Coupled Plasma (ICP)
Flow analyzers
I have no experiene with any of the above.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

Please check all of the following computer programs you have experience using.

Laboratory Information Management System (LIMS)
Microsoft Word or similar word processing software
Microsoft Excel or similar speadsheet software
E-mail program
I have no experience with any of the above.
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

 

How often do you perform algebraic calculations?

On a daily basis
On a weekly basis
A few times a month
Rarely or not at all
 

Please list the school or employer and job title where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below.