Project SEARCH Intern Self-Preparation Assessment 
Language
  • English (US)
  • Spanish (Latin America)

  • Project SEARCH Intern Self-Preparation Assessment

  • Please fill out this checklist. If you need help, please ask a family member or support staff. Fill out each section with the best information about yourself and your skills. That will help us learn more about you. If someone else helps you, ask them to write down the answers in your own words.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Birthday*
     - -
  • Commitment to Community Employment (check all that apply)

  • Commitment to Community Employment

  • I want to get a job*
  • I want to work at least 16 hours a week*
  • My family wants me to work*
  • I am willing to change things in my schedule for a job opportunity*
  • I have an original Social Security Card*
  • I have a business like email address that I can check at least weekly*
  • Job Readiness (check all that apply)

  • Job Readiness

  • I have a State ID or a Driver’s license*
  • I can pass a pre-employment drug screen*
  • I can pass a criminal background check*
  • I receive SSI and/or SSDI or other forms of public assistance*
  • I have had a benefits analysis and/or I understand the impact of earned income on my benefits*
  • I have a cell phone you can call me on*
  • I have a voicemail set up on my cell phone with a professional greeting*
  • I can stay independently, without supervision, at home and work**

  • *Note: Interns in Project SEARCH are expected to work without one-on-one help after initial training. Skills trainers will train you, check in with you, and will help you solve problems when needed. Skills trainers will not be with you all the time. Internships will also have coworkers there who can also provide help sometimes and answer questions. Coworkers cannot be with you all the time either. Interns are at internships 20 hours a week.

  • Attendance (check one of the following)*

  • Independent Daily Living and Self Care Skills

  • On a scale of 1-5 (1 being 'I need a lot of help' and 5 being 'I don’t need much help'), rate yourself in these areas:

  •

  • Appearance and Professional Presentation

  • I arrive at school, work, or activities every day with:
  • I arrive at school, work, or activities every day with clean and combed hair:*
  • I arrive at school, work, or activities every day with clean clothing and underwear:*
  • I arrive at school, work, or activities every day with brushed teeth/oral hygiene:*
  • I arrive at school, work, or activities every day with deodorant:*
  • How I dress
  • I wear appropriate clothing for the weather*
  • I follow my school/work dress code*
  • I am willing to follow the designated dress code of my employer including rules on appropriate clothing, shoes, facial hair, facial and body piercings, tattoos, jewelry, and fingernail polish and length:*
  • I am willing to follow the designated dress code of my employer including rules on:

  • Transportation

  • Please select all that apply
  • I have reliable transportation to get to work*
  • I have my own car, driver’s license and insurance*
  • I know how to use public transportation*
  • I’m willing to learn to use public transportation*
  • I use public transportation and can make my own ride appointments*
  • I use public transportation and another person schedules my ride appointments*
  • I have a family member/ care provider who is willing to provide on-going transportation*
  • I have other transportation options*

  • Appropriate Social and Behavior Skills

  • Please select all that apply
  • I do not hold hands, hug, kiss, flirt, or touch people in private areas at school or work (or other inappropriate times)*
  • I do not swear or use profanity in a school or work setting*
  • I show respect to my peers and co-workers*
  • I work cooperatively with others*
  • I accept correction and criticism without a negative reaction*
  • I have lost my temper at school, work or in a community place*
  • I have had aggressive behavior in a community place:

  • Interpersonal Communication

  • Please select all that apply
  • I respond when someone speaks or asks questions*
  • I make eye contact*
  • I use an appropriate tone of voice*
  • I engage in appropriate conversation in a school or work environment*
  • I use a cell phone and electronics and can follow rules with them at school or work. Examples: not using the phone while working, using headphones while on break.*
  • I talk about the same topics over and over again*
  • I use appropriate body language in a school or work environment. (i.e., no inappropriate hand gestures, sitting appropriately in a chair / posture, and respecting personal space)*
  • I use appropriate body language in a school or work environment:

  • Verbal Communication

  • Please select all that apply
  • I am easily understood by others*
  • I sometimes have trouble getting my message across to others*
  • I use adaptive equipment to communicate*
  • I am willing to learn to use adaptive equipment to communicate if appropriate*
  • I use an interpreter and/or use sign language to communicate*

  • Recreational Activities

  • I participate in organized group activities:*
  • I like to exercise on my own (walking, running, biking, etc.)*
  • I like sit-down activities such as:*

  • Physical Limitations

  • Please select all that apply
  • I have difficulty walking*
  • I have limited use of my arms and/or hands*
  • I have other physical limitations that may affect my employment*
  • I need to use the following to help me walk/navigate:

  • Production Rate and Work Quality

  • Please select all that apply
  • At school or work, I get all my tasks finished on time and I turn things in by the due date*
  • At school or work, it is difficult to get all my tasks finished on time or turned in by the due date*
  • At school or work, I get most of the tasks correct*
  • At school, on chores or on my job my work is organized and neat*

  • Employability Skills

  • Please select all that apply
  • I get ready for school, work or other appointments on time by myself*
  • After lunch or break, I get back to class or work on time by myself*
  • I know how to tell, and keep track of time*
  • I stay on task until it is finished*
  • If I am interrupted, I can return to the task and finish it without help*
  • I can access the necessary information to fill out an application*
  • I know how to answer common interview questions*
  • I can tell my boss or co-workers ways that I learn best or tools that help me be a good worker*

  • Prior Work Experience

  • Computer/Electronic Skills

  • Please select all that apply
  • I have basic keyboarding skills and use correct typing techniques*
  • I have basic keyboarding skills and use only two fingers (hunt and peck)*
  • I can use Microsoft Word to create letters and other documents*
  • I can use Microsoft Excel to create spreadsheets and other documents*
  • I can use email correctly*
  • I can access the internet to get information by using sites like Google or Map Quest*
  • I use a cell phone to talk to others*
  • I use a cell phone for texting*

  • Problem Solving and Conflict Resolution

  • Please give us some examples of how you would solve these problems. If someone writes the answers for you, have them do it on your own words.

  • Thank you for taking the time to finish this information and checklist! We appreciate it!

  • Should be Empty: