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#20-005165-0012
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.

Are you fluent in American Sign Language?  

Yes No
2.

Describe your experience providing career counseling and case management.  Include employer, job duties, and dates of employment.  If no experience, indicate N/A.

3.

Describe your direct 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.

5.

Describe in detail your professional experience assisting others with employment preparation. Please list all job seeking tools and resources utilized. Please include name of employer, job title, dates of employment, and hours worked per week.  This information must also be reflected in your applications.  If you do not possess experience in this area, indicate N/A.


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