SELF-EMPLOYMENT VERIFICATION FORM

Transcription

1 SELF-EMPLOYMENT VERIFICATION FORM The individual named on this form is applying to the Registry of Professional Vocational Evaluators (RPVE). The purpose of the PVE registry is to provide a credential for vocational evaluators who have demonstrated attainment of acceptable standards of education, training, experience, and knowledge. This credential aids in the promotion and quality of the vocational evaluation profession. More information about the Registry of Professional Vocational Evaluators can be found at. The applicant has indicated that he or she has provided vocational evaluation services to your agency or your service recipients. The applicant signified that he or she is self-employed. Self-employment includes individuals who own a business and operate as independent contractors, individuals who are members of a partnership that carries on a business, and individuals who are otherwise in business for themselves. If you can vouch that the applicant is self-employed and provides services to your agency or your service recipients, please complete sections 3, 4, and 5 of this form. An applicant s eligibility into RPVE can only be evaluated if this verification form is completed in its entirety. Sections 3, 4, and 5 of this form must be completed by someone from the Referral Agency who has witnessed vocational evaluation services. Please note that this is not a performance evaluation, but rather a form to help determine whether the applicant possesses the required knowledge and skills in vocational evaluation. If you can provide verification for this applicant: 1. Please complete Sections 3, 4, and 5 of this form; and 2. Sign the form and return it to the applicant. Self-Employment Verification Form Page 1 of 5

2 1. Applicant Information First Name Middle Initial Last Name Address Phone Number Street Address Apt./Suite Number City State Zip/Postal Code 2. Release Statement I,, am applying to the Registry of Professional Vocational Evaluators and am required to provide verification of my work experience. I give my permission for the Referral Agency to release this information to the Registry for the purpose of determining my eligibility. My application cannot be processed until this information is provided. Signature of PVE Applicant Date (mm/dd/yyyy) Self-Employment Verification Form Page 2 of 5

3 3. Information Supplied by Referral Agency Name & Address of Referral Agency Name of Agency Representative Providing Verification Phone Number of Agency Representative Address of Agency Representative Applicant s Position Title While Working for Agency Applicant Service Start Date (mm/dd/yyyy) Applicant Service End Date (mm/dd/yyyy) Number of Service Hours Provided per Week by Applicant 4. Applicant Knowledge and Skills The following tables list skills and knowledge areas that are functions of the vocational evaluation profession. Please indicate whether the skills described were observed or not. Feel free to provide more specific comments at the end of this form. Self-Employment Verification Form Page 3 of 5

4 Vocational Evaluation Applicant provides community-based or work sample assessments. Applicant demonstrates knowledge of work performance and work behavior (gives feedback on what a person is able to do, what a person is unable to do, stamina level, attitude present, etc.) Applicant demonstrates the ability to modify and accommodate the evaluation techniques used according to client needs. Psychometric Testing and Vocational Assessment Applicant has knowledge of scoring and interpreting standardized tests and instruments. Applicant is able to select and administer tests or other instruments based upon the specific needs of the client. Applicant is able to interpret test results to an understandable and useful level for both the agency and the client. Occupational Analysis and Job Placement Applicant is able to perform a job or task analysis (breakdown of job demands.) Applicant is able to provide labor market information (information about current employment and education trends.) Applicant can perform a transferable skills analysis (relate past work skills and abilities to new opportunities, keeping in mind current physical status.) Applicant has computer literacy and skills necessary for accessing today s application and job search needs. Medical Aspects of Disability Applicant demonstrates knowledge of medical and physical implications of disability. Applicant demonstrates knowledge of psychosocial implications of disability (psychological and social factors which impact one s life.) Applicant demonstrates knowledge of cultural aspects of life and disability. Applicant can perform a functional skills assessment (can determine what a person can and cannot do.) Self-Employment Verification Form Page 4 of 5

5 Professional Abilities Applicant demonstrates communication skills necessary to convey evaluation results to agency and client at an understandable level. Applicant demonstrates written communication skills appropriate for completion of a vocational evaluation report and any other documentation wanted by the agency. Applicant demonstrates collaboration and interpersonal skills needed to ensure that both the agency and the client had informed choice throughout the evaluation process. Applicant adheres to ethical and legal principles of the profession (maintains confidentiality, uses release of information forms, etc.) Other Knowledge and Skills Demonstrated by Applicant 5. Referral Agency Verification Statement Based on my observations, the designations and comments provided are representative of the knowledge and skills demonstrated by the below-named applicant in his or her provision of vocational evaluation services. I also attest that the applicant provided services to my agency as a self-employed entity. RPVE Applicant Name Name of Referral Agency Name of Agency Representative Signature of Agency Representative Date (mm/dd/yyyy) Self-Employment Verification Form Page 5 of 5