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Human Capital Management
#190426-X49B-04


Supplemental Questionnaire

Last Name First Name
 

 

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire.  The questions below will be used for scoring purposes in lieu of a written exam.


1.

What experience do you have communicating with others on a professional level?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
2.

What is your experience referring or assisting individuals with developmental delays to obtain community resources?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
3.

What is your experience assisting individuals with disabilities in the selection, acquisition, or use of assistive technology devices?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
4.

What is your experience analyzing and assessing strengths and barriers to education of children with developmental delays?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
5.

Please check all of the following experience you have providing individual and family services.

Planning individualized education/service plans
Writing individualized outcomes for children and families
Obtaining family resources
Maintaining confidential records
Establishing eligibility for children
I have no experience performing these tasks.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
6.

Please check all of the experience you have instructing or teaching children with physical or developmental delays.

Orientation and mobility
Social-emotional skills
Self-help skills
Communication skills
Play activities
Early literacy
Transition skills
I have no experience performing this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
7.

What experience do you have developing and maintaining networks with businesses like child care facilities, agencies, public facilities, or organizations?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
8.

What experience do you have preparing clear and concise oral or written reports?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
9.

What experience do you have analyzing complex situations and adopting appropriate courses of action?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
10.

Please check all of the experience you have performing case management duties.

Researching information
Compiling reports
Entering data into software applications
Interpreting laws, rules, regulations and procedures
Providing assistance in the completion of required forms
Counseling and assisting clients in using appropriate resources
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
11.

What experience do you have monitoring the progress of children enrolled in educational programs?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.

12.

Please check all types of evaluations you have experience administering.

Battelle Developmental Inventory (BDI2)
Ages and Stages Questionnaire (ASQ)
Birth to Three Assessment (B-3)
Preschool Language Scale (PLS4)
Early Learning Accomplishment Profile (ELAP)
Another type of assessment tool used in early intervention or special education that is not listed above
I have no experience with this task.
 

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above. If you indicated "no experience", then please type N/A in the box.

13.

What experience do you have working with families from a variety of cultures?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.

14.

Please check all of the following computer programs you have experience using.

Microsoft Word or similar word processing software
Microsoft Excel or similar spreadsheet software
Microsoft Outlook or similar email program
I have no experience with any of the above.
 

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.

15.

What experience do you have in mediation or conflict resolution?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 
Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.
16.

What experience do you have managing multiple tasks with deadlines?

I have performed this task independently as a regular part of my job.
I have performed this task as a regular part of my job under supervision.
I am familiar with this task or have received some training on it.
I have no experience with this task.
 

Please list the employer and job title or school name and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A in the box.