Supplemental Questionnaire

	Placer County Human Resources Department
	Occupational Therapist - I
	#2016-14317-01
	Supplemental Questionnaire


Last Name	First Name

This is the supplemental questionnaire for the classification of Occupational Therapist I. Part I is not scored. Part II of this supplemental questionnaire will be scored based on your checked responses. Narratives provided by applicants describing training and/or experience will not be scored but will be available to the hiring authority and may be utilized for interview and selection determinations.

Part I: Minimum Qualifications (Not Scored)

Do you possess the equivalent to a Bachelor's degree from an accredited college or university with major course work in occupational therapy or a related field?

Yes No

Do you possess a valid certificate of registration issued by the American Occupational Therapy Association?

Yes No

Part II: Please answer based on your training and/or experiences the following questions. Based on your checked responses, your job-related training and experience will be scored and then ranked. Narratives provided by applicants describing training and/or experience will not be scored but will be available to the hiring authority and may be utilized for interview and selection determinations.

Evaluating, planning and providing occupational therapy for children in a clinic, home or school setting.

I have no training or experience or I have very limited experience performing these tasks.

I have limited training and/or experience performing these tasks.

I have some experience performing these tasks but would need additional training.

I have performed these tasks independently under normal supervision.

I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.

If you indicated any experience above, please describe below.

Teaching self-care activities emphasizing muscle re-education involving reach, grasp, release, coordination and balance.

I have no training or experience or I have very limited experience performing these tasks.

I have limited training and/or experience performing these tasks.

I have some experience performing these tasks but would need additional training.

I have performed these tasks independently under normal supervision.

I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.

If you indicated any experience above, please describe below.

Developing positioning plans for the severely disabled children relative to physical functioning and daily living skills.

I have no training or experience or I have very limited experience performing these tasks.

I have limited training and/or experience performing these tasks.

I have some experience performing these tasks but would need additional training.

I have performed these tasks independently under normal supervision.

I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.

If you indicated any experience above, please describe below.

Keeping clinical notes and records and preparing reports.

I have no training or experience or I have very limited experience performing these tasks.

I have limited training and/or experience performing these tasks.

I have some experience performing these tasks but would need additional training.

I have performed these tasks independently under normal supervision.

I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.

If you indicated any experience above, please describe below.

Instructing parents in home follow-up and use of special equipment.

I have no training or experience or I have very limited experience performing these tasks.

I have limited training and/or experience performing these tasks.

I have some experience performing these tasks but would need additional training.

I have performed these tasks independently under normal supervision.

I have extensive experience performing these tasks and have trained and/or supervised others in the performance of these tasks.

If you indicated any experience above, please describe below.

Knowledge of principles and methods of occupational therapy.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Knowledge of theory of mental and physical rehabilitation.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Knowledge of skeletal anatomy and kinesiology.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Knowledge of basic pathology and neurology involved in cerebral palsy and other disabling conditions such as myelomeningocele, amputations and arthritis, relative to the objectives of occupational therapy.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Knowledge of principles of growth and development of children.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Knowledge of physical and psychological problems of physically disabled children and their families.

I possess none or a very limited amount of this knowledge.

I possess this knowledge but have not applied it in a job setting.

I have applied this knowledge under close supervision.

I have applied this knowledge independently under normal supervision.

I have used this knowledge to train or provide consultation to others.

If you indicated any knowledge above, please describe below.

Ability to teach children with disabilities the fundamentals of self-care and other suitable activities.

I possess none or a very limited amount of this ability.

I possess this ability but have not applied it in a job setting.

I have applied this ability under close supervision.

I have applied this ability independently under normal supervision.

I have used this ability to train or provide consultation to others.

If you indicated any ability above, please describe below.

Ability to teach and explain occupational therapy to children, parents, teachers and other professionals.

I possess none or a very limited amount of this ability.

I possess this ability but have not applied it in a job setting.

I have applied this ability under close supervision.

I have applied this ability independently under normal supervision.

I have used this ability to train or provide consultation to others.

If you indicated any ability above, please describe below.

Ability to use equipment and supplies utilized in occupational therapy.

I possess none or a very limited amount of this ability.

I possess this ability but have not applied it in a job setting.

I have applied this ability under close supervision.

I have I have applied this ability independently under normal supervision.

I have used this ability to train or provide consultation to others.

If you indicated any ability above, please describe below.

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