Vocational Questionnaire

FOR: DEPOSITION PREPARATION

from: CRC Services, LLC Printable PDF version, click here.

 

EDUCATIONAL BACKGROUND:


Highest education completed (begin w/high school):

  • Where attended? ______________________________________________

  • Dates: _________________________________________________________

  • Course Levels (basic, college prep, honors, AP): _______________

  • Grade Average: __________

  • Diagnosed Learning Disabilities? ______________________________

SPED services? On IEP or 504? Medications? ___________



College Training:

  • Name of School: _________________________________________________

  • Graduated? __________

  • Degree/Major: ___________________________

  • Dates attended: ___________________________

  • GPA: __________


Other Training (e.g., truck driving, apprenticeships, computer classes, company-internal training):

  • Name of school/training facility: ________________________________________

  • Dates of attendance: ___________________________

  • Certifications: _______________________________________________________

  • Licenses: ___________________________________________________________

  • Apprenticeship (# hours completed): ___________________________

Belong to Union? Which one? ___________________________

  • Are licenses and/or certifications still current? If not, when did they lapse?

What is needed for reinstatement? _______________________________



 

MILITARY BACKGROUND:


  • Branch: ___________________________

  • Dates of service: ___________________________

  • M.O.S. (job in military): ___________________________

  • Training received: ___________________________


  • Any service-connected disabilities? ___________________________

- If yes- what is the rating? ___________________________

- What body parts? ___________________________

- Access VR&E Program (e.g., Vocational Rehabilitation/if yes, obtain specifics)?

_____________________________________



 

COMPUTER SKILLS/EXPERIENCE:

  • Smartphone:

Able to: text, use apps, email, games, other? ___________________________

  • Tablet:

Uses: ___________________________

  • Social Media/Network (Facebook, Twitter, Instagram, LinkedIn, other):

How often post? _______________

  • On-line activity (e.g., Bill paying, shopping, social media, Facetime, etc.):

Activities: ________________________________________________________

  • Microsoft Office Software Knowledge:

Word __________ Excel __________

PowerPoint __________

  • Other Software Knowledge (detailed for jobs in I.T., Graphic Design, & computer-based occupations): ____________________________________________________________________

 

WORK HISTORY (MOST RECENT JOB FIRST):

  • Name of Employer: _______________________________________________________

  • Location: _______________________________________________________

  • Job Title (chronology if changed over time): _________________________________

  • Wage: __________________ Commission (explain structure): ________________

  • Job duties: ________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

  • Certifications/Training/Licenses required: _____________________________

  • Computer Use (software used, % workday, data entry v. narrative or other): _________________________________

  • Manual recordkeeping? __________________

  • Tools/Machinery Used: ________________________________________________________________________ ________________________________________________________________________

  • Heaviest weight lifted? ____________ Heaviest object lifted?_____________

  • How often? ______________ By self or w/help? ______________

  • % of day Sitting ____________ Standing ____________ Walking ____________

  • Can job be performed from sitting or standing posture (i.e. sit/stand option)? __________

  • Job Performances: ________________________________________________________

  • Why did job end (quit-why, termination-why)?________________________________________________________________________

  • If any light duty performed described # hours/wk, job duties, how long accommodated? _________________________________

  • *For non-English speaking- how did they communicate with the employer/coworkers? _______________________________________________________________________


 

JOB SEARCHES:

  • When did job searches begin? _________________________________

  • Develop a resume? (Who developed it?) __________________ Request copy.

  • Request copy of all job search records (Indeed profile, resume, cover letter, email verifications, etc.). ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

  • Method (i.e. Indeed, Monster, Career Builder, in-person, LinkedIn, networking efforts): _______________________________________________________________________ ________________________________________________________________________

  • Types of job applying for? _______________________________________

  • No. of job applications submitted: _________________________________

  • List limitations on job application/job search profile/emails? __________________________

  • Any calls for interviews? ______________

  • If yes, how many & outcome? ________________________________________________

  • Advise employer of limitations? ______________

  • If offered a job and declined it- why? ______________________________________________

  • Understanding of work restrictions (and from which doctor): ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

  • Ask plaintiff if he/she thinks they can work –include an entry level job within his/her restrictions-if not, why not? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

 

ADDITIONAL NOTES:

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