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#19-001742-0002
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***


1

Describe your professional work experience investigating alleged discrimination complaints in the following areas of concentration: housing, employment and public accommodations based on race, color, ancestry or national origin, religion/creed, sex, marital status, disability, age, sexual orientation, gender identity, genetic information and familial status. In your response provide dates of employment, job title, and employer name. If you do not have this type of work experience, indicate N/A. 

2

Describe your professional work experience negotiating agreements to settle discrimination complaints in the following areas of concentration: housing, employment and public accommodations based on race, color, ancestry or national origin, religion/creed, sex, marital status, disability, age, sexual orientation, gender identity, genetic information and familial status. In your response provide dates of employment, job title, and employer name. If you do not have this type of work experience, indicate N/A.

3

Do you have a minimum of 1 year of professional work experience in human relations, civil rights, legal work, community relations, law enforcement, personnel, counseling or social work? (this type of experience may account for six months of the required experience).

Yes No
4

Please indicate whether you possess work experience in any of the following areas.  (Select all that apply.)

Civil Rights Issues
Legal/Court Room Proceedings
Alternative Dispute Resolution
Accessibility Issues
Housing Discrimination Issues
None of the above.
5

Describe your Legal writing experience.  If you do not have this type of experience, indicate N/A.

6

Please list undergraduate or graduate course work you have completed in the areas of: Civil Rights, Housing Discrimination, Americans with Disabilities Act, and/or Equal Employment Law.  If you do not have this experience, please indicate N/A.

7

Choose the answer that best reflects your ability to communicate in Spanish.

Fluent
Proficient
Intermediate
Beginner
I am not able to communicate in Spanish

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