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#20-005044-0005
Supplemental Questionnaire

Last Name
First Name
1.

Are you proficient 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 your experience preparing others for employment using job seeking tools and resources.  Include employer, job duties and dates of employment.  If no experience, indicate N/A.


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