California Department of Health Services

EXAMINATION QUESTIONNAIRE
RESEARCH SCIENTIST I
(PHYSICAL/ENGINERRING SCIENCES)

Examination title: Research Scientist I (Physical/Engineering Sciences)

Name and address:

Thank you for your interest in California State civil service employment. The State of California is an Equal
Employment Opportunity employer. The Research Scientist I (Physical/Engineering Sciences) examination
will consist of a Training and Experience Questionnaire that will be used to evaluate your knowledge,
experience, training, and familiarity or understanding of a particular subject or issue.

This is a scored test and will account for 100% of your rating. It is important that you fill the questionnaire
out completely and accurately. YOUR RESPONSES ARE SUBJECT TO VERIFICATION. Your responses
should be an accurate reflection of your personal experience and training.

Candidates who fail to follow the instructions will be eliminated from this examination.

THIS AFFIRMATION MUST BE COMPLETED:

I hereby certify and understand that the information provided by me on this questionnaire is true and
complete to the best of my knowledge and contains no willful misrepresentation or falsifications. I
understand this information will be verified and may be discussed in a hiring interview. I also understand
that if it is discovered that I have made any false representations, I will be removed from the examination
process, removed from the list resulting from the examination, or dismissed from civil service status.

Signature Print name Date

Send completed application questionnaire package to:

California Department of Health Services

Personnel Management Branch
MS 1300–1302
P.O. Box 997411
Sacramento, CA 95899-7411

IMPORTANT NOTE: Please ensure that the envelope has adequate postage. Facsimiles (FAX) will
NOT be accepted under any circumstances.

Page 1 (FORM 631) COMP—PMB 104

 California Department of Health Services
EXAMINATION QUESTIONNAIRE
RESEARCH SCIENTIST II
(PHYSICAL/ENGINEERING SCIENCES)

GENERAL INSTRUCTIONS

1. The attached questionnaire will constitute the entire examination. Additional instructions are provided within
the questionnaire.

2. Your responses to the questions must be provided on the questionnaire. Answer all questions for each
knowledge, experience, and/or other column as requested.

NOTE: The first part titled “KNOWLEDGE AND EXPERIENCE” requires two responses; one
response for knowledge and one for experience. Rate each your knowledge and experience.

For the part titled “EDUCATION,” special care should be taken to submitting a complete description
of your education.

Any questions without a response will not be accounted for in your total score.

3. You must submit a complete examination application package. Missing information will delay the processing
of your examination.

The following documents comprise a complete examination application package for each Research
Scientist I, II, and III:

Completed Employment Application (STD. 678) which can be found at:

(http://www.spb.ca.gov/employment/employment_app2.htm)
Affirmation Statement (Page 1)
Conditions of Employment (Form 631) (Page 3)
Training and Experience Questionnaire (Begins on Page 4)

4. Before you mail the examination material, please keep a photocopy of the examination application package
for your records. In the event that you are called for a hiring interview, you may be requested to provide a
copy of this questionnaire.

5. Upon receipt of your completed examination application package, documents become confidential
information and are the property of the California Department of Health Services, Selection Unit. Due to its
confidential nature, such information cannot be returned.

6. It is your responsibility to notify the California Department of Health Services, Selection Unit, of any changes
in your address. All correspondence must include the examination title, your identification number, and your
social security number. Send correspondence to:

California Department of Health Services

Personnel Management Branch
MS 1300–1302
P.O. Box 997411
Sacramento, CA 95899-7411

Page 2 (FORM 631) COMP—PMB 104

 California Department of Health Services
EXAMINATION APPLICATION PACKAGE
RESEARCH SCIENTIST I
(PHYSICAL/ENGINEERING SCIENCES)

CONDITIONS OF EMPLOYMENT

Name: Date:

Examination title: Research Scientist I (Physical/Engineering Sciences)

If you are successful in the examination, your name will be placed on the active employment list and certified to fill
vacancies according to the conditions you specify on this form. If you are unwilling to accept work or do not reply
promptly to communications, your name will be placed on the inactive list.

LOCATIONS IN WHICH YOU ARE WILLING TO WORK:

Please check your choices—you will not be offered a job in locations not checked. If more than 15 checks are made, you
may be considered available for work anywhere in the State.

(5) ANYWHERE IN THE STATE (IF CHECKED, NO FURTHER SELECTION IS NECESSARY.)

8004 ANYWHERE IN THE NORTHERN REGION—OR MARK NORTHERN REGION COUNTY CHOICES:
0400 Butte 2300 Mendocino 4600 Sierra
0600 Colusa 2500 Modoc 4700 Siskiyou DEL
NORTE
SISKIYOU MODOC

0800 Del Norte 2900 Nevada 5100 Sutter

1100 Glenn 3100 Placer 5200 Tehama DT
SHASTA
OL
TRINITY LASSEN

1200 Humboldt 3200 Plumas 5300 Trinity

MB
HU

1700 Lake 4500 Shasta 5800 Yuba TEHAMA

PLUMAS

1800 Lassen O CIN

O GLENN BUTTE SIERRA
ND
ME BA DA
COLUSA VA
YU NE
SU

PLACER
LAKE
TT
ER

8001 ANYWHERE IN THE CENTRAL REGION—OR MARK CENTRAL REGION COUNTY CHOICES: SO
NO
YOLO
EL DORADO

MA NAPA TO
Alpine
EN
OR
AD
AM AS
0100 Alameda 2200 Mariposa 4100 San Mateo AM ER
R
SOLANO SAC AV
MA AL
RIN SAN C TUOLUMNE
CONTRA JOAQUIN
MONO
0200 Alpine 2400 Merced 4300 Santa Clara SAN FRANCISCO
COSTA
ALAMEDA LA
US
RIP
OS
A
IS
AN MA
ST
0300 Amador 2700 Monterey 4400 Santa Cruz SAN MATEO SA
NT
A
CL
AR MERCED
SANTA A MADERA
0500 Calaveras 2800 Napa 4800 Solano CRUZ SA
N
BE FRESNO INYO
NIT

0700 Contra Costa 3400 Sacramento 4900 Sonoma

O
MO
NT TULARE
ER
EY

0900 El Dorado 3500 San Benito 5000 Stanislaus KINGS

SA

1000 Fresno 3800 San Francisco 5500 Tuolumne N

LU
IS
OB
ISP
KERN
O

2000 Madera 3900 San Joaquin 5700 Yolo SAN BERNARDINO

2100 Marin SANTA BARBARA

VENTURA LOS ANGELES

OR RIVERSIDE

8011 ANYWHERE IN THE SOUTHERN REGION—OR MARK SOUTHERN REGION COUNTY CHOICES: AN
GE

1300 Imperial 2600 Mono 4000 San Luis Obispo SAN DIEGO
IMPERIAL

1400 Inyo 3000 Orange 4200 Santa Barbara

1500 Kern 3300 Riverside 5400 Tulare
1600 Kings 3600 San Bernardino 5600 Ventura
1900 Los Angeles 3700 San Diego

TYPE OF EMPLOYMENT DESIRED:

Permanent Limited Term Full-Time Part-Time Intermittent

Page 3 (FORM 631) COMP—PMB 104

Examination title: Research Scientist I (Physical/Engineering Sciences)

INSTRUCTIONS: ALL CANDIDATES MUST COMPLETE QUESTIONS 1–32.

KNOWLEDGE AND EXPERIENCE

NOTE: In evaluating the amount of experience (paid or voluntary) you have in a particular subject
area, unless it was performed on a full-time basis, all part-time and/or intermittent experience
must be computed and converted to full-time equivalency and reflected as such in your
response. For example, half-time employment for six months is equivalent to three months
full-time.

Rate both your knowledge and experience separately for each of the following:

Extensive experience (four or more years)

Moderate experience (one to three years)
Some experience (less than one year)
No experience

Moderate/extensive knowledge
Basic/limited knowledge
No knowledge

1. Identification and selection of appropriate problem for study . . . . . . . . . . . . . 0 1 2 0 1 2 3

2. Development of study hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

3. Selection of appropriate study design, analytical approach, sampling scheme,

and data collection methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

4. Maintain quality control on data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

5. Application of physical and/or engineering measurements . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

6. Perform statistical analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

7. Use of computer software to analyze data . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

Name the software: ______________________________________________

8. Evaluation of research methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

9. Provide technical consultation to independent and departmental investigators 0 1 2 0 1 2 3

10. Critically review literature relevant to methods and interpretation of findings. . 0 1 2 0 1 2 3

11. Work as part of a multidisciplinary team:

a. Project team member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

b. Serve in a lead or supervisory role . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

c. Principal or coprincipal investigator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

d. Consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

12. Prepare report(s) of research findings for publications . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

NOTE: All information provided on this Questionnaire is subject to verification.

COMP—PMB 89 (9/04) Page 4

Examination title: Research Scientist I (Physical/Engineering Sciences)

KNOWLEDGE AND EXPERIENCE (Cont.)

Extensive experience (four or more years)

Moderate experience (one to three years)
Some experience (less than one year)
No experience

Moderate/extensive knowledge
Basic/limited knowledge
No knowledge

13. Conduct presentation(s) to scientific groups/public. . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

14. Work with media (e.g., responding to reporters, television, or radio interviews) 0 1 2 0 1 2 3

15. Relate findings to health policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

16. Assist in performing research grant proposals for funding . . . . . . . . . . . . . . . 0 1 2 0 1 2 3

EXPERIENCE IN SELECTED COMPONENTS OF RESEARCH

Count only those proposals or research projects in Physical/Engineering Sciences or a closely

related field.

Six or more
Three to five
One to two
None

17. Number of research proposals prepared for internal or external peer review . . . . . . . . . 0 1 2 3

List the research proposals:

18. Number of research projects funded as a result of a research proposal in which you
have served as a principal investigator, co-investigator, researcher, or consultant . . . . . 0 1 2 3

19. Number of research projects in which you selected the methodology . . . . . . . . . . . . . . . 0 1 2 3

20. Number of research projects in which you performed the data analysis . . . . . . . . . . . . . 0 1 2 3

21. Number of research projects in which you are/were responsible for the data analysis,
but did not perform the analysis yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

NOTE: All information provided on this Questionnaire is subject to verification.

COMP—PMB 89 (9/04) Page 5

Examination title: Research Scientist I (Physical/Engineering Sciences)

EXPERIENCE IN PUBLICATIONS AND PRESENTATIONS

Count only those publications and presentations in Physical and Engineering Sciences or a closely
related field.

Six or more
Three to five
One to two
None

22. Number of first authored publications you have in peer reviewed scientific journals . . . . 0 1 2 3

23. Number of co-authored publications you have in peer reviewed scientific journals
(excluding those counted in the previous question). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

24. Number of technical reports you have prepared as a first author or co-author (excluding
those counted in the previous question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

25. Number of oral or poster presentation(s) you have presented at professional scientific
meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

26. Number of lay person fact sheets on scientific issues that you have prepared . . . . . . . . 0 1 2 3

27. Number of oral presentations on scientific topics you have made before lay audiences 0 1 2 3

EXPERIENCE IN PROVIDING TRAINING, TECHNICAL ASSISTANCE, AND EXPERTISE

Count only those training sessions, associations, journals, and situations in Physical and Engineering
Sciences or a closely related field.

Six or more
Three to five
One to two
None

28. Number of training sessions or classes you have prepared and/or conducted in your
professional career . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

29. Number of scientific articles you have peer reviewed for journals . . . . . . . . . . . . . . . . . . 0 1 2 3

30. Number of public health situations in which you have provided technical input with
regard to health warnings or new policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 2 3

31. Number of professional memberships with nationally recognized associations . . . . . . . . 0 1 2 3

NOTE: All information provided on this Questionnaire is subject to verification.

COMP—PMB 89 (9/04) Page 6

Examination title: Research Scientist I (Physical/Engineering Sciences)

EDUCATION

32. Describe your academic professional education that is relevant to the Research Scientist
classification:

U Identify any additional education beyond the bachelor’s degree, such as an advance degree in
the specialty or a closely related field.

U Please identify your area of academic education and the title of your research thesis, study, or
project. Describe the research problem you evaluated and the conclusions of your research.

U Please identify professional training programs that you completed and certifications you possess.

NOTE: All information provided on this Questionnaire is subject to verification.

COMP—PMB 89 (9/04) Page 7

 CALIFORNIA DEPARTMENT OF HEALTH SERVICES

Examination Title: Research Scientist I (Physical/Engineering Sciences)

EXAMINATION INFORMATION TO APPLICANT:

You have completed the examination for the Research Scientist I (Physical/Engineering
Sciences) examination. Test results will be mailed to you within four to six weeks after the
date your completed application examination package is received.

Reminder: You must submit a complete examination application package which is

comprised of the following documents:
O Completed Employment Application (STD. 678)

(http://www.spb.ca.gov/employment/employment_app2.htm)
O Signed Affirmation Statement

O Completed Conditions of Employment (Form 631)

O Completed Training and Experience Questionnaire

Mail the complete examination application package to:

California Department of Health Services

Personnel Management Branch
MS 1300–1302
P.O. Box 997411
Sacramento, CA 95899-7411

If you have any questions regarding this examination, please contact the Selection Unit staff
at (916) 552-8344.

NOTE: All information provided on this Questionnaire is subject to verification.

COMP—PMB 89 (9/04) Page 8