Preliminary trainee selection questionnaire
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PERSONAL HISTORY AND EDUCATION |
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Name (Mr., Ms, title) |
Family name |
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Age |
Date/month/year of birth |
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Nationality |
Religion |
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Education |
Year finished education |
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Name of school |
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Special ability |
Occupation |
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Address No. Street |
Village |
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Sub-district / district |
Province |
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Marital status |
If married, name of spouse |
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Spouse age |
Spouse occupation |
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Income (candidate) |
Income (spouse) |
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Number of children |
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Who takes care of the children? |
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FAMILY HISTORY |
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Father's given name |
Father's family name |
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Age |
Alive or deceased |
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Occupation |
Income (per day/per month/per year) |
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Mother's given name |
Mothers' family name |
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Age |
Alive or deceased |
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Occupation |
Income (per day/per month/per year) |
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Status of marriage of parents |
New marriage |
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How many brothers and sisters (grand father, grand mother on each side of the family, and other relatives)? |
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Name of brothers and sisters |
Age |
Occupation |
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HISTORY OF DISABILITY |
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What is your disability? |
Cause? |
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Since when? |
Where did you receive rehabilitation? |
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What is the ability of the body at the moment of the interview? |
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How are the eyes used, how does the candidate drink... use his/her hands? |
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Left-handed or right-handed? |
How much weight can the candidate lift? |
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Can he or she stand or not? |
For how long? |
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Can he or she walk or not? How far? |
Use of prosthesis / orthotic / wheelchair. |
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Can he or she sit or not? |
If yes, for how long? |
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If lower part of the body has no feeling, can he/she control bladder and bowel movements? |
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HISTORY OF WORK |
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What was the last occupation? |
Position? |
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Where is location of work? |
Salary? |
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When did candidate give up this occupation? |
Reason for leaving? |
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INFORMATION ON TRAINING |
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Where did you learn about training? Why do you want to join the training? |
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Where did you apply? |
When did you apply? |
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Do you know when the training will start? |
Are you available during that time? |
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What does your family say about the training? |
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What does your community say about training? |
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Do you wish to set up a micro-enterprise after the training? |
What would be your preferred occupation? |
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STATUS OF HOUSE AND LAND |
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What are your family duties? |
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What is your financial situation? Do you have any debts? |
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Can you travel by yourself? |
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Do you own land? |
Size of land? |
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Can the land be used to start enterprise after training? |
Space available for enterprise? |
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COMMENTS OF INTERVIEWER |
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