D.4 Key Personnel.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C24222Q0821
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Text version
D.4 Offeror’s Key Personnel Roster
For Board Certified Diagnostic Medical Physicists Candidates for prescreening determination for Bronx VAMC
RFQ: 36C24222Q0821
Candidate Number 1:
1. Full Name:
2. Residence address:
3. Cell Phone:
4. Email address:
5. State License/Certification and expiration date:
6. Medica Liability Insurance exp Date:
7. National Criminal History Check (NCHC) copy provided if one has been conducted in the past: Yes or NO, copy if obtained is required.
Candidate Number 2:
1. Full Name:
2. Residence address:
3. Cell Phone:
4. Email address:
5. State License/Certification and expiration date:
6. Medica Liability Insurance exp Date:
7. National Criminal History Check (NCHC) copy provided if one has been conducted in the past: Yes or NO, copy if obtained is required.
Candidate Number 3:
1. Full Name:
2. Residence address:
3. Cell Phone:
4. Email address:
5. State License/Certification and expiration date:
6. Medica Liability Insurance exp Date:
7. National Criminal History Check (NCHC) copy provided if one has been conducted in the past: Yes or NO, copy if obtained is required.
Candidate Number 4:
1. Full Name:
2. Residence address:
3. Cell Phone:
4. Email address:
5. State License/Certification and expiration date:
6. Medica Liability Insurance exp Date:
7. National Criminal History Check (NCHC) copy provided if one has been conducted in the past: Yes or NO, copy if obtained is required.
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