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#21-005044-0004
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.***


1.

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

2.

Describe your experience in vocational rehabilitation and/or other human services related field.  Please include name of employer, job title, dates of employment, and hours worked per week.  This information must also be reflected in your application.  If no experience, indicate N/A.

 

3.

Do you have professional experience working with students with disabilities? If yes, please include name of employer, job title, dates of employment, and hours worked per week.  This information must also be reflected in your application.  If no experience, indicate N/A.

 

4.

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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