S-10000-00003770 Attachment D~1.pdf

RFA – OregonBuys Bid: S-10000-00003770 Attachment D

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ATTACHMENT D – EMPLOYEE QUALIFICATIONS

CHECKLIST

One Attachment D must be submitted for each employee that will be providing Vocational Rehabilitation (VR) Job Placement Services.

Include with each Attachment D copies of all requested documentation stated in Section

4.1.4 of the Solicitation.

By submitting and signing this Attachment D, the person named below is affirming they have the qualifications to provide the Job Placement Services as described in the Solicitation and Attachment E “Contract Template”.

Printed Name: ________________________________________________________________________________

Business Name: ________________________________________________________________________________

CHECK THE APPROPRIATE BOXES THAT APPLY:

1. Are you a new Contractor or an existing Contractor under RFA S-10000-00000385?

☐ New

☐ Existing

2. Will you be performing Job Placement Services (Only check one box)?

☐ Yes, I will be performing Job Placement Services?

This box should be checked for all person(s) providing Job Placement Services under this contract.

☐ No, I will NOT be performing Job Placement Services?

This box should be checked if the person signing this Attachment D will not be providing Job Placement Services, such as an owner or a director, who will not be an actual service provider but will be named as the contract signee.

3. What VR Participant Tracks will you be working with (Check all that apply)?

☐ Track 1

☐ Track 2

☐ Track 3

RFA – OregonBuys Bid: S-10000-00003770 Attachment D

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4. Have you attended the required Job Placement Services Contract Training (JPSCT) and all 12 Core Competency modules as stated in Section 3.2. and 3.3?

☐ JPSCT

☐ All 12 Core Competencies modules

5. If you will be providing Track 2 and Track 3 Services, do you (minimum of 1 box must be checked):

☐ Have six (6) months of prior experience working as a Job Coach or Job Developer

☐ A bachelor’s degree in Rehabilitation Counseling or Special Education

☐ Have one (1) year of documented experience working with individuals with disabilities

☐ Certified Employment Supported Professional (CESP) certificate, ☐ Completion of the Association of People Supporting Employment First (APSE) collaborative training, ☐ Possess an Association of Community Rehabilitation Educators (ACRE) training certificate

☐ Have one (1) year of human services related experience, such as economical disadvantages, employment, abuse and neglect, substance abuse, aging, disabilities, prevention, health, cultural competencies, or housing.

☐ I will not be providing Track 2 and Track 3 Services

6. Section 4.1.4 requires that all Contractors and Contractors employees submit additional documentation with Attachment D, did you provide:

☐ Current and Approved ORCHARDS Criminal History Background Check

☐ JPSCT certificate (or transcript denoting the attendance of the JPSCT)

☐ All 12 Core Competency module certificates (or transcript denoting the CCs)

☐ An ACRE, CESP or APSE collaborative training Certificate

☐ Bachelor’s Degree (copy) in Rehabilitation Counseling or Special Education

☐ Resume’

7. If you are an Individualized Placement Support (IPS) provider, are you qualified under the mental health IPS model to provide IPS services under the Contract and provide official proof with the submission of Attachment D?

☐ Yes

☐ No

By signing below, I confirm I meet the requirements and qualifications for the Services checked above.

Signature Date