Supported Employment: Building Your Program - SAMHSA Store ...

Vocational ProfileWork history continuedNext most recent jobWhat did you like bestabout the job??What were the job duties?Reason for leavingthe jobPrevious job: _________________________ Job title: __________________Job started: ____/___/_____ Job ended: ____/___/_____Number of hours worked per week: _________Job duties:Why did the job end?Note: Attach resume tocapture additionalwork history.Current adjustmentDiagnosisProdromal symptomsWhat are the first signs thatyou may be experiencing asymptom flare-up?How would I be able to tellif you are having a bad dayor not feeling well?Coping strategiesWhat do you do to makeyourself feel better?Medication managementWhat medication do youtake and when do youtake it?Physical healthHow would you rate yourphysical health?Do you have any physicallimitations that mightinfluence your work? Whatare they?EnduranceHow many days per weekwould you like to work?How many hours a day?First signs of a flare-up:Signs of a bad day:Medication: ______________________________ When you take it: _____________Medication: ______________________________ When you take it: _____________Medication: ______________________________ When you take it: _____________ExcellentGoodFairPoorPhysical limitations:Most number of days per week: _________Most number of hours per day: _________Tips for Agency Administrators and SE Leaders 30 Building Your Program