The reference form has moved please go to the NRCM information page and select the "Reference Form" link.
I. APPLICANT DATA
Dates of applicant’s employment
(mm/dd/yyyy) to (mm/dd/yyyy):
Select what you judge to be the most accurate description of the applicant's employment. (Choose one.)
Using the applicant’s job description, estimate the amount of time the applicant devotes to each activity listed below. (The total must equal 100%).
Using the applicant’s job description, describe the applicant’s duties:
Concurrent with a formal training program?
If yes, please include detailed information
concerning number of hours employed, type of experience obtained, etc.
Participation in a
will be evaluated on an individual basis.
Evaluate the applicant's capacity to function as a microbiologist within the laboratory OR as a biological safety
officer. If the applicant is a supervisor, please evaluate his/her supervisory skills as well.
By checking this box, I verify that all the information on this page is complete and accurate to the best of my knowledge.
1752 N Street, N.W. Washington, D.C. 20036
tel-202.942.9257 • fax-202.942.9353 • web-http://www.asm.org/index.php/professional-certification