Must be completed by applicant’s current or former immediate supervisor.
No letter of recommendation is required.
How have you overseen the applicant's training and/or experience?
Dates of applicant’s employment (mm/dd/yyyy) to (mm/dd/yyyy):
In his/her position, does/did the applicant work full-time in a clinical, public health, reference, or other microbiology laboratory?
Responsibilities and skills in the clinical laboratory
(e.g., assisting medical technologists in interpreting the clinical significance of laboratory findings, oversight of quality assurance/quality control,
technical troubleshooting and problem solving)
Please provide a detailed description.
Interaction with healthcare providers
(e.g., consultation with healthcare providers regarding the selection
and interpretation of clinical microbiology tests/results; consultation with local and state public health officials; reference lab consultation with clients; participation in hospital/institution committees [infection
control, antibiotic subcommittee, etc.])
Management and administrative skills
(e.g., interacting with institutional and laboratory administration and personnel; performing financial analyses on new test methods or laboratory programs; assuring/overseeing accreditation, competency, proficiency testing, etc.)
Research (e.g., development/evaluation of new test methods/techniques/ instrumentation; collaboration with clinical/basic research colleagues) Please provide a detailed description.
Teaching (e.g., formal lectures and rounds; resident/fellow/student training) Please provide a detailed description.
Other
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