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● ● ● Quality Care + Professional Staff ● ● ●
VISIONQWEST HEALTHCARE │ 500 N Central │ Suite 740 │ Glendale, CA 91203 │ www.vqstaff.com │ Phone: (818) 547- 0497 ext. 2 │Fax: (818) 547- 0449
ESSENTIAL/PRACTICAL SELF ASSESSMENT SKILLS CHECKLIST
PRINTED NAME _________________________________________________ TITLE: _______________________
SIGNATURE: _____________________________________________________ DATE:________________________
By accurately filling out this checklist, you will help us match your skills and interests with available assignments. Please place an "X" in the column that best describes your experience level with each skill.
Level of Proficiency: 1 Can function independently 2 Experienced but may need review 3 Limited experience 4 No experience