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Human Capital Management
#170922-K23A-04


Supplemental Questionnaire

Last Name First Name
 

 

ATTENTION!

Please verify that you meet the education and experience requirements listed in the job bulletin before completing the following supplemental questionnaire.  The questions below will be used for scoring purposes in lieu of a written exam.


1.

What is your experience being an advocate for a person who is blind?

I have had classes or training on this task but have not yet performed it on the job.
I have performed this task on the job in a learning capacity. I received training on how to do the task and performed the task regularly. My work on this task was monitored fairly closely by a supervisor or senior employee to ensure compliance with proper procedures.
I have performed this task as a regular part of a job. I have performed it independently and normally without review by a supervisor or senior employee.
I am considered an expert in performing this task. I have supervised performance of this task or am normally the person who is consulted by other workers to assist them in doing this task because of my expertise.
I have no experience performing this task.
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

2.

Please check all experience you have providing case management to persons who are blind.

Planning curriculum
Independent living plan
Counseling and guidance
Maintaining records
Establishing eligibility for clients
I have no experience performing this task
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

3.

Please check all experience you have conducting individual needs assessments for people who are blind.

Employment resources and referrals
Community resources
Specialized services for blindness and low vision.
Tracking progress
I have no experience performing this task.
 

Please list the employer and job title or school and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

4.

What is your experience accessing community resources for people who are blind? 

I have had classes or training on this task but have not yet performed it on the job.
I have performed this task on the job in a learning capacity. I received training on how to do the task and performed the task regularly. My work on this task was monitored fairly closely by a supervisor or senior employee to ensure compliance with proper procedures.
I have performed this task as a regular part of a job. I have performed it independently and normally without review by a supervisor or senior employee.
I am considered an expert in performing this task. I have supervised performance of this task or am normally the person who is consulted by other workers to assist them in doing this task because of my expertise.
I have no experience performing this task.
 

Please list the employer and job title or school and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

5.

Please check all experience you have instructing or teaching people who are blind.

Orientation and mobility
Braille
Home management and independent living
Assistive technology and communication
Leisure time activities
I have no experience performing this task.
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

6.

What is your experience developing lesson plans for individuals or groups on blindness related issues?

I have had classes or training on this task but have not yet performed it on the job.
I have performed this task on the job in a learning capacity. I received training on how to do the task and performed the task regularly. My work on this task was monitored fairly closely by a supervisor or senior employee to ensure compliance with proper procedures.
I have performed this task as a regular part of a job. I have performed it independently and normally without review by a supervisor or senior employee.
I am considered an expert in performing this task. I have supervised performance of this task or am normally the person who is consulted by other workers to assist them in doing this task because of my expertise.
I have no experience performing this task.
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

7.

What is your experience assessing individualsto identify the extent of their blindness and limitations?

I have had classes or training on this task but have not yet performed it on the job.
I have performed this task on the job in a learning capacity. I received training on how to do the task and performed the task regularly. My work on this task was monitored fairly closely by a supervisor or senior employee to ensure compliance with proper procedures.
I have performed this task as a regular part of a job. I have performed it independently and normally without review by a supervisor or senior employee.
I am considered an expert in performing this task. I have supervised performance of this task or am normally the person who is consulted by other workers to assist them in doing this task because of my expertise.
I have no experience performing this task.
 

Please list the employer and job title or school and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

8.
What is your experience interpreting rules, regulations, and/or laws related to disabilities?
I have had classes or training on this task but have not yet performed it on the job.
I have performed this task on the job in a learning capacity. I received training on how to do the task and performed the task regularly. My work on this task was monitored fairly closely by a supervisor or senior employee to ensure compliance with proper procedures.
I have performed this task as a regular part of a job. I have performed it independently and normally without review by a supervisor or senior employee.
I am considered an expert in performing this task. I have supervised performance of this task or am normally the person who is consulted by other workers to assist them in doing this task because of my expertise.
I have no experience performing this task.
 

Please list the employer and job title or school and location where you gained your experience as indicated in the response above.  If you indicated "no experience", then please type N/A below. 

9.

What is the largest group of people to which you have made a presentation?

50 and above
10-49
1-9
I have no experience performing this task.
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

10.

Please check all experience you have providing information relating to disabilities to others.

Writing or editing news articles
Answering phone calls
Developing community resources
Handing out literature at public events
Educating/training others (staff, civic groups, etc.)
I have no experience performing this task.
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.

11.

Are you fluent in any language other than English?

Yes No
 

Please list the employer and job title, school and location, or location of volunteer work where you gained your experience as indicated in the response above. If you indicated "no experience", then please write N/A below.


 

Please make sure that you attach all requested documents to your application, if requested.  Resumes should be attached to the "Resume" tab and any other requested documents to the "Other" tab.