Basic Info

First Name: *
Last Name: *
Email: *
Phone: *
Former FDA Employee?:
Please check this box if you are a former employee of the Food & Drug Administration
Expert Witness:
If you are a former FDA employee, and are interested in Expert Witness work, check this box
Pharmaceuticals:
Please check the box if you have experience working in Pharmaceuticals
Medical Device:
Please check the box if you have experience working with Medical Devices
Quality:
Please check the box if QA or QC is your area of expertise
Regulatory Affairs:
Please check the box if Regulatory Affairs is your area of expertise
510K:
Please check the box if 510Ks are your area of expertise
Pharmacovigilance:
Please check this box if Pharmacovigilance is your area of expertise
Auditor:
Please check the box if you are a certified auditor
GLP:
Please check the box if you have GLP experience
GCP:
Please check the box if you have GCP experience
GMP:
Please check the box if you have GMP experience

Address Information

Address: *
City: *
State/Province: *
Zip/Postal Code: *
Country: *

Professional Details

Notes about rate:
Interested in: *
Please select the type of work you are interested in hearing about
Remote only:
Please check this box if you are only interested in remote work/projects
Content contributor:
Please check box if you are interested in contributing to webinars, whitepapers, newsletters, etc.
Hourly Rate or Annual Salary: *
Enter your hourly consulting rate (i.e. 100.00) or target annual base salary (i.e. 100000)

Other Info

Source:
How did you hear about us?: *

Social Links

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Attachment Information

Cover Letter:
Resume: *
Please submit in Microsoft Word format
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