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#21-005044-0022
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 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.

3.

Please describe your professional experience working with students with disabilities. Include in your response the name of employer(s), dates of employment, and relevant job duties. If you do not have this experience, enter 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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