Sage Profile
CalWORKs Career Assessment
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
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First Name
Last Name
For the following, please mark the physical demands that you have a problem with or CANNOT do. Check all that apply.
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Climbing
Balancing
Stooping
Kneeling
Crouching
Crawling
Reaching
Handling
Fingering
Feeling
Talking
Hearing
Tasting/Smelling
Near Acuity (clarity of vision at 20 inches or less)
Far Acuity (clarity of vision at 20 feet or more)
Depth Perception (Three-Dimensional vision. Ability to judge distance sand spatial relationships so as to see objects where and as they actually are)
Accommodation (adjustment of lens of eye to bring an object onto sharp focus. This factor is required when doing near point work at varying distances from the eye)
Color Vision (Ability to identify and distinguish colors)
Field of Vision (Observing an area that can be seen up and down or to the right or left while eyes are fixed on a given point)
I am able to perform all of the above physical activities
For the following, please mark the work environment that you DO NOT like and DO NOT want to be in. Check all that apply.
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Exposure to weather
Extreme cold
Extreme heat
Wet and/or humid
Vibration (exposure to a shaking object or surface)
Atmospheric Conditions (Exposure to conditions such as fumes, noxious odors, dust, mists, gases, and poor ventilation that affect the respiratory system, eyes, or skin)
Proximity to moving or mechanical parts
Exposure to electric shock
Working in high, exposed places
Exposure to radiation
Working with Explosives
Exposure to toxic of caustic chemicals
Other environmental conditions
I can work in all of the above work environments
For the following, please mark the noise intensity level that you CANNOT work in. Check all that apply.
Very Quiet
Quiet
Moderate
Loud
Very Loud
I can work in all of the above noise levels
For the following, please mark for the temperament/adaptability requirement or job duties that you would LIKE to do. Check all that apply.
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Performing REPETITIVE or Short-Cycle Work: Doing the same task or following the same steps over again many times each day
INFLUENCING People in Their own Opinions, Attitudes, and Judgements: Getting them to do the things you want them to do
Performing a VARIETY of Duties: Being able to change tasks quickly. Doing many different types of work during the day
EXPRESSING Personal Feelings: Creating art or criticizing the art of others. Using Imagination and creativity
Working ALONE or Apart in Physical Isolation from Others: For long periods of time you don't see other people face-to-face
Working Efficiently under STRESS: Working under stress caused by emergencies, danger, or criticism. working very fast or concentrating very hard
Attaining Precise Set Limits, TOLERANCES, and Standards: Being very precise in making things, doing arithmetic, recording data, or inspecting things
Working UNDER Specific Instructions: There is little or no rom for independent action or judgement
Dealing with PEOPLE: Working together with others or helping them (more than just giving or receiving instructions)
Making JUDGEMENTS and Decisions: Making decisions based on what you see, hear, smell, or touch
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