Official SealSan Joaquin County Human Resources Division


#0919-EH4090-EX
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a valid certificate as a Public Health Microbiologist issued by the California Department of Public Health?

Yes No

 

If you answered yes, you must submit a copy of the original certificate along with your application or via email to kwatson@sjgov.org.

If you answered no, you do not qualify for this recruitment.



2.

You must qualify under the federal Clinical Laboratory Improvement Amendments (CLIA) as incorporated in to California Health and Safety Code using one of the three patterns listed below.


2a.

Pattern I

Possession of a Doctorate degree from an accredited university in a chemical, physical, biological, or laboratory science, including all undergraduate and graduate coursework required to meet the requirements to be appointed as a director of a public health laboratory as identified by the State of California, Department of Public Health, Laboratory Field Services.

Provide the name of the degree, the major, and university where the degree was completed.

 

And Either

a) Possession of a valid certificate by a CLIA-approved board

OR

b) Before February 24, 2003, must have worked two years as a director supervising or directing in a laboratory performing high complexity testing and must have at least two years of laboratory training.

In the space provided below either provide the title of the CLIA board approved certificate (and a copy via email) or the name of employer and dates of employment served as a director in a laboratory as described in letter b.

 

2b.

Pattern II

To qualify under this pattern, on or before February 28, 1992, held a position as a laboratory director or could have qualified as a laboratory director under California regulations (42 CFR 493.1415, published March 14, 1990) or federal regulations (55 FR 9538).

In the space provided below list the name of the employer, dates of employment, and job title.

2c.

Pattern III

To qualify under pattern III, on or before February 28, 1992, was qualified under state law to direct a laboratory in the state in which the laboratory is located.

In the space provided below please detail your relevant experience including name of employer and dates of employment.

3.

Two years of management experience in an approved public health laboratory is desirable.

In the space provided, describe your experience, if any, managing a public health laboratory. Include in your answer the name of the employer, dates of employment, job title, and job duties performed.