APPLICATION

Work Incentives Planning & Assistance (WIPA)

Community Work Incentives Coordinator

Please complete all sections and return with a cover letter explaining why you are interested in this position. You may also attach a resume to this application. Applications due Thursday, September 3, 2015 by 5:00 pm.

Email:

Mail: Disability Rights Oregon, 610 SW Broadway, Suite 200, Portland, OR 97205

FAX: (503) 243-1738

(Note: DRO’s office hours are M-F, 9:00 am 12:00 pm and 1:00 pm to 5:00 pm.) An electronic version is available at:

A. Personal Information

Name
Address
Telephone/Email

B. Education/Training

Years of School Completed
Degrees Earned School Attended & Year Obtained
Other Relevant Training
Relevant Volunteer Activities

C. Work History (Put current position first and then previous positions)

Employer #1

Employer & Address/Phone
Dates of Employment
Position:
Reason for Leaving
Primary Responsibilities
May We Contact: / Yes No

Employer #2

Employer & Address/Phone
Dates of Employment
Position:
Reason for Leaving
Primary Responsibilities
May We Contact / Yes No

Employer #3

Employer & Address/Phone
Dates of Employment
Position:
Reason for Leaving
Primary Responsibilities
May We Contact / Yes No

Employer #4

Employer & Address/Phone
Dates of Employment
Position:
Reason for Leaving
Primary Responsibilities
May We Contact / Yes No

Please add separate sheets for additional employers.

D. The person in this position assists SSI and SSDI beneficiaries in understanding how returning to work will impact their cash benefits, health benefits and other state benefits. The position requires: the ability to interpret federal and state laws and regulations about public benefits and the ability to explain complex information in simple terms, both verbally and in writing. The position requires good math skills, excellent attention to details, deductive ability with analytical thinking and creative problem solving. Please relate how your background and experience has prepared you for this type of position.

E. Included in the responsibilities of this position is getting information and working with the Social Security Administration, other organizations and agencies serving the client community. Describe your experience in working with governmental agencies and non-profit organizations.

F. What experience have you had in working as a member of a team? Describe the qualities that make you a good team player?

G. List three reasons why individuals receiving disability benefits would be fearful of losing their benefits and three reasons why they may want to work.

H. The position requires good verbal and written communication skills. The successful candidate provides training to small groups, interacts with other community and governmental organizations, and writes informational brochures. Describe your experience in these areas.

I. The program uses a national database for case management, reports and data analysis. Please describe your experience working with databases, utilizing the reporting features, and analyzing data. Include any experience with Word, Excel and Access.

J. Please describe your experience working with individuals of diverse backgrounds and with disabilities in the work, social or family setting.

K. Other Information

1. Do you possess any special skills which would be considered valuable in this job?

2. Is there anything else you would like us to consider in reviewing your application?

L. References

Please list 3 professional references (supervisors preferred):

Name / Relationship & # of Years / Address and Phone

M. Have you ever been convicted of any crime, have a pending criminal case or had a substantiated abuse complaint?  Yes  No

If yes, please explain.

Notice: If you are selected for this position, you will be required to successfully complete a federal background check from the Social Security Administration. Your employment will also be contingent upon being provisionally certified by Social Security as a Community Work Incentives Coordinator within 3 months of hire. You will be provided training for the certification.

Declaration

I declare that the information contained in this application is accurate. Falsifying any information on this application can be considered grounds for rejection of the application or dismissal if employed.

______

Signature Date