WorkAbility Survey

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WorkAbility Survey

2017-2018

First name and last name *

Grade

My cell phone or home number

Can I text you WorkAbility related information on this number?

Yes

Clear selection

My email (or parent's email)

Who is my WorkAbility Employment Developer?

Mrs. Prather

Mrs. Schreck

Mrs. Tostenson

Clear selection

My School *

El Dorado High School

Oak Ridge High School

Ponderosa High School

Union Mine High School

Virtual Academy

Independence High School

Here's what I do in my spare time (activities, sports, special interests and hobbies):

I have worked the following places (paid or volunteer, or helping family, etc.)

Some things I'm considering for after high school are: *

4 year college

Community College (Such as Folsom Lake College)

Enlist in the Military

Attend a Trade School

Work Full-Time

Undecided

Other:

Required

Some careers that sound interesting to me are:

These ROP courses sound interesting to me:

Welding

Law Enforcement

Fire Control Technician

Animal Health

Auto Engine

Diesel Engine

Cosmetology

Culinary Arts

Dental Assisting

AP Computer Science

Health Careers

Architecture/CAD

I currently work at:

(leave blank if you don't have a job right now)

While in High School I can see myself working at:

(somewhere around here, during high school)

What I am doing right now to help me reach my goals:

I'm doing my homework

I'm studying for tests

I have a job

I do volunteer work

I have hobbies related to my future goals (explain below, under "Other")

I ask for help when I need it, from teachers, parents and other adults in my life

I'm taking an elective or class that relates to my career goals (explain below, under "Other")

Other:

I learn best by...

Hearing information (lecture in class, listening to directions, hearing a speech, etc.)

Hands on/Trying it myself

Seeing a demonstration or model (Youtube video, teacher demonstration)

Multisensory - a combination of seeing, hearing and doing

Other:

Check any that apply to you:

I have a resume I can use to apply for a job

I need help to create a resume

I'm thinking - "What's a resume???"

I have filled out a job application before

I have someone who can help me fill out job applications

I would like help at school to fill out a job application

I have a driver's license or plan to get one in high school

YES

I am currently working on it

Not sure

Clear selection

If I could have ANY job in the world, I would choose to be...

Dream big! This is just for fun!

My school counselor is:

My caseload (IEP) manager is: *

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