If currently active duty in the U.S. Military, provide anticipated date of separation/retirement or start of terminal leave (mm/dd/yyyy).
Type of Discharge and/or anticipated Type of Discharge:
If retired because of a service connected disability, transferred to the permanent disability retirement list, or currently receiving compensation for a service connected disability, indicate the percentage of the disability:
1. Do you have ability to do the work of a Medical Equipment Repairer without more than normal supervision? Your experience should demonstrate the ability to perform duties such as: installing, maintaining, overhauling, repairing, and/or testing various medical equipment used in patient diagnosis and treatment.
For each of the items below, select the one statement that most accurately describes your training and experience using the scale provided.
2. Perform routine periodic maintenance for sophisticated medical and/or dental equipment such as: ultra-centrifuges, high pressure liquid chromatographs, liquid phase sequencers, lyophilizers, spectrophotometers and/or electrophoresis equipment.
3. Repair and/or maintain ultra centrifuges, high pressure liquid chromatography equipment, liquid phase sequencers, lyophilizers, spectrophotometers, and/or electrophoresis equipment.
4. Test the full-range of medical and/or research equipment to ensure proper functioning.
5. Use electronic test equipment to test closed-circuit television systems and/or mini and micro computers.
6. Follow medical equipment operational and/or safety requirements to safely operate equipment.
7. Provide assistance to research requirements, equipment specification, installation requirements, maintenance requirements, operational, and/or safety requirements.
8. Test, repair, and/or calibrate shop equipment to ensure accurate repair or calibration procedures on scientific equipment.
9. Apply knowledge in the electronic trade to make repairs on medical equipment.
10. Research and/or document equipment specifications, installation requirements, and/or maintenance requirements for medical equipment.
11. Provide instruction for non-journeyman mechanics for practices of the medical equipment repair trade.
12. Use blueprints, schematic drawing, liquid and/or air flow sheets to plan or execute work assignments.
13. Interpret medical equipment maintenance requirements to perform routine periodic maintenance on sophisticated items such as ultra-centrifuges, liquid chromatographs, and/or liquid phase sequencers.
14. Operate ohmmeters to perform repairs on medical equipment.
15. Operate calipers to perform repairs on medical equipment.
16. Operate pressure gauges to perform repairs on medical equipment.
17. Operate voltmeters to perform repairs on medical equipment.
18. Repair or modify electronic equipment, such as: pulse type control systems, digital logic circuitry, A/D, and D/A conversion circuits, and/or LSI and MSI circuits.
19. Test and/or calibrate a full-range of medical and/or medical research equipment to determine if repairs are needed.
20. Test and/or analyze computer data to repair or maintain medical equipment with automatic sequencing.
21. Your ratings in this Occupational Questionnaire are subject to evaluation and verification based on the documents and references you submit. Deliberate attempts to falsify or inflate your responses may be grounds for not referring you.
Please take this opportunity to review your rating to ensure the accuracy of your answers and that they are supported by your resume. Failure to agree to the statement below will disqualify you from further consideration for the position.