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#21-005044-0020
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.

Describe your experience facilitating group instruction and interacting with consumers in a group setting.  Include employer, job duties, number of hours worked per week and dates of employment.  If no experience, indicate N/A.

4.

Describe your experience preparing others for employment and interacting with the business community.  Include employer, duties, and date of employment.  If no experience, indicate N/A.

5.

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.


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