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#20-005044-0001
Supplemental Questionnaire

Last Name
First Name
1.

Describe your experience facilitating group instruction and interacting with consumers in a group setting.  Include employer, job duties, number of hours worked per week and dates of employment.  If no experience, indicate N/A.

2.

Describe your experience in career counseling, employment preparation and case management.  Include employer, job duties, number of hours worked per week and dates of employment.  If no experience, indicate N/A.

3.

Describe your experience working in the vocational rehabilitation field and/or human services or related field.  Include employer, job duties, number of hours worked per week and dates of employment.  If no experience, indicate N/A.

4.

Describe your professional experience working with individuals with disabilities.  Include employer, job duties, dates of employment and number of hours worked per week.  If no experience, indicate N/A.


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