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Human Capital Management
#210813-K21B-10


Supplemental Questionnaire

Last Name First Name
 
 

Do you currently possess or are you eligible to sit for the following certification/licensure exams?
(Check all that apply)

Certified Rehabilitation Counselor (CRC)
Licensed Professional Counselor (LPC)
Certified Vocational Evaluator (CVE)
Professional Vocational Evaluator (PVE)
None of the above

 

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 is your experience providing guidance or counseling to individuals with disabilities?

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 performing this task.
 

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

2.

What is your experience assessing individuals to identify the extent of their disabilities and limitations?

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 performing this task.
 

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

3.

What is your experience conducting comprehensive needs assessment for individuals with disabilities?

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 performing this task.
 

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

4.

What is your experience managing multiple cases simultaneously and maintaining timely documentation?

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

5.

What is your experience referring or assisting individuals with disabilities 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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

6.

Please check all experience you have with rules, regulations, or laws related to disabilities. 

I have interpreted rules, regulations, or laws related to disabilities.
I have explained rules, regulations, or laws related to disabilities to individuals.
I have advised businesses or organizations how to properly follow rules, regulations, or laws related to disabilities.
I have trained groups on rules, regulations, or laws related to disabilities.
I have researched rules, regulations, or laws related to disabilities.
I have no experience with any of these tasks.
 

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

7.

What is your experience preparing, interpreting or utilizing vocational evaluation 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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

8.

What is your experience planning and arranging for vocational rehabilitation services?

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

9.

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

10.

What is your experience conferring with public and private employers to establish job opportunities for individuals with disabilities?

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

11.

What is your experience analyzing and assessing strengths and barriers to employment of individuals with disabilities?

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below.

12.

What is your experience being an advocate for individuals with disabilities?

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 and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

13.

Please check all active certifications you currently hold.

Certified Rehabilitation Counselor (CRC)
Licensed Professional Counselor (LPC)
Certified Vocational Evaluator (CVE)
Professional Vocational Evaluator (PVE)
I hold another certification not listed.
I currently do not hold any certifications.
 

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