Exhibit_G_-_Affirmation_of_Qualifications_-_Pre-ETS.docx
DOCX document 19 KB Posted
- Attached to
- Master Agreement AZ|CTR056116
- Contract number
- CTR056116
- Issued by
- Arizona
About this file
The document is an Affirmation of Qualifications form for Pre-Employment Transition Services (Pre-ETS) associated with a state rehabilitation services contract, specifically for the Rehabilitation Services Administration (RSA). The form is designed to verify the qualifications of employees or subcontractors who will provide direct services to RSA clients, with a focus on supporting individuals with disabilities in workplace entry and employment success.
The qualifications outlined in the document specify detailed educational and professional experience requirements for service providers, including options for staff with master's degrees, bachelor's degrees, high school diplomas, or equivalent experience working directly with individuals with disabilities. Additional specialized qualifications are noted for sign language interpreters, requiring valid state licensing or specific national certifications. The form provides flexible staffing options, allowing less experienced personnel to work under supervision on preliminary tasks, while ensuring a baseline of competence in disability awareness, workplace barriers, employment strategies, and client support services.
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Text version
Affirmation of Qualifications Pre-Employment Transition Services Legal Business Name:
| I affirm that | , an |_| employee OR |_| subcontractor, shall be providing direct services to RSA clients as specified in the contract and meets the following qualifications: | ||
| |_| | Has documented knowledge and competence in disabilities awareness, in barriers and issues preventing individuals with disabilities from entering and succeeding in the workplace, in strategies necessary for achieving successful, long-term employment outcomes for individuals with disabilities and how these strategies lead to improved employment outcomes, and in work readiness and employment skills AND | ||
| |_| | Has a Master’s Degree in a related field (e.g., Rehabilitation Counseling, Psychology, Sociology, Education, etc.) and documentation of one (1) year of full-time employment working with individuals with disabilities; OR | ||
| |_| | Has a Bachelor’s degree in a related field (e.g. Rehabilitation Counseling, Psychology, Sociology, Education, etc.) and documentation of three (3) years' full-time employment in working with individuals with disabilities; OR | ||
| |_| | Has a high school diploma or G.E.D. and documentation of seven (7) years of experience directly working with individuals with disabilities, preferably involved in the provision of vocational rehabilitation services; OR | ||
| |_| | Does not have the above qualifications, but is providing direct services under this contract and has a high school diploma or G.E.D. and one (1) year of documented experience (preferably working with individuals with disabilities and involved in the provision of vocational rehabilitation services). This individual shall be utilized only as follows: | ||
| On a limited basis and when assigned tasks that would be considered preliminary or less technical in nature, and | |||
| Under the direction and supervision of staff member who meets the criteria above. | |||
| |_| | Will be providing direct services to clients under this contract utilizing American Sign Language and | ||
| |_| | has a valid Arizona Sign Language Interpreter license OR | ||
| has one of the following certifications: | |||
| |_| | Registry of Interpreters for the Deaf (RID) Certificate of Interpretation as listed in the Scope of Work | ||
| |_| | Board for Evaluation of Interpreters Basic, Advanced, Master, Court Interpreter | ||
| |_| | National Association of the Deaf Interpreting Certification (NAD) IV or V; | ||
| |_| | Sign Communication Proficiency Interview (SCPI) rating of Intermediate or above | ||
| |_| | American Sign Language Teacher’s Certification (ASLTA) Qualified or Professional levels | ||
| |_| | Will be providing direct services to clients under this contract utilizing a foreign language and is able to communicate effectively and accurately using the foreign language. By signing this affirmation we assume responsibility for their performance. |
In signing below, I affirm that this person has the qualifications noted above and the documentation is on file with this business.
| Printed Name | Title | Date |
2018-09-27 bw
File details come from the government source that posted it. Updated .