1(PENA) Version: 8.0 - (25/10/2015)

Personal Employment Needs Analysis Form (PENA)

5(PENA) Version: 8.0 - (25/10/2015)

The PENA supports the Employment Advisor to make semi-structured interviews with the jobseeker.

The purpose of this tool is to:

. 1 Support the jobseeker to identify his/her strengths and employment support needs.

. 2 Support the Employment Advisor and the jobseeker (and family if needed) to achieve successful employment which matches the jobseekers skills, abilities, desires and supports.

Personal Employment Needs Analysis Form (PENA)

All sections of the PENA must be considered in relation to each jobseeker.If a section is not applicable to a jobseeker, tick (P) in the “Considered N/A” checkbox and enter the date.

If the “Considered N/A” checkbox is not available, the question is mandatory and must be completed.

Considered N/A Date

PENA

. 1 Introduction

. 2 Basic Information

a. Personal Informationb. CVc. Family Circumstancesd. Financial Incomee. Transportation

f. Daily Activitiesg. Disability and Employment Considerationsh. Optionsi. Attachments

. 3 Education and Training History

. 4 Occupational and Employment History

. 5 Future Plans – Hopes and Dreams

. 6 Job Accommodation Considerations

. 7 Summary of Strengths

. 8 Summary of Employment Support Needs

(PENA) Version: 8.0 - (25/10/2015)6

Reference Number

Name

Date of Birth

Place of Residence

Tawafuq Survey Results Type of Disability

Functional Category

Chronic condition

CV Developed

Marital Status

Registered in MLSD?

Family Member Name Relationship Employer

Are there any family members who are working?

List any family members and where there may be a job opportunity in his/her place of work

Yes No

Family obligations?

Number of dependents

Family Information

Hijri

City

Gregorian

North

Yes No

Yes No

If yes, type of chronic condition

East

Age

in Arabicmale

Female

Gender

in English

Join Date (attachment)

National ID Number

Number of Journey Weeks

Central

West

South

Yes

Single Married Divorced Widowed

NoTip: Use information in the CV to save time administering the PENA

Priority goal in employment plan

Considered N/A Date

7(PENA) Version: 8.0 - (25/10/2015)

Do you currently have �nancial income? Yes No

What is the desired distance to work? Please choose the distance for a single journey

0-11 km 11 – 30 km 31 – 50 km + 50 km

Financial Income

Sources of Financial Income

Amount AmountSource Source

Support Services and Allowances Received

Type ImpactSource

Transportation: What transport do you use?

Available for workType of Transportation Available

Private car/ drive by yourself

Private car with private driver

Family

Friend

Taxi

Others, specify

Not available for work

Yes Yes with help I can’tCan you manage money on your own e.g. pay the bills?

Considered N/A Date

Considered N/A Date

(PENA) Version: 8.0 - (25/10/2015)8

Daily Life Activities :

Do you need support with any of the following daily life activities:

Type of Activity

Bathing

Using lavatories

Eating

Type of Required SupportYes No

Considered N/A Date

Disability and Employment Considerations

Considered N/A Date

Describe how you typically spend your day?

Are there any tasks that you �nd di�cult or impossible?

Do you use any supports to help you complete these tasks?

Have you ever used any supports whether in school, University or at work?

Yes (What are they?)

Yes (What are they?) OptionsNo

No (What supports you would like to have)

Education and Training History (mention the details of the last two certi�cates you achieved)

Options

School/College/University

Elementary School

Do you currently go to a doctor/specialist?

Secondary School

Writing and readingin Arabic

Writing and readingin English

High School

University Stage

Vocational Training

Certi�cate Graduation Year

Employability Skills

Speaking English

General Job Skills Evidence of Skills ?How does the jobseeker describe his skills?

Social Media(Twitter, Facebook,

Instagram, Snapchat)

Internet Excellent Good Beginner I can’t

E-mail Excellent Good Beginner I can’t

Excellent Good Beginner I can’t

Computer skills How does the jobseeker describe his skills? Evidence of Skills ?

Microsoft Word Excellent Good Beginner I can’t

Microsoft Excel Excellent Good Beginner I can’t

Microsoft PowerPoint Excellent Good Beginner I can’t

Microsoft Access Excellent Good Beginner I can’t

Others Excellent Good Beginner I can’t

Ms O�ce Skills How does the jobseeker describe his skills? Evidence of Skills ?

General Health and WellnessConsiderations

Considered N/A Date

Yes No

Do you have a current medical report? Yes No

9(PENA) Version: 8.0 - (25/10/2015)

Education and Training History (mention the details of the last two certi�cates you achieved)

Options

School/College/University

Elementary School

Do you currently go to a doctor/specialist?

Secondary School

Writing and readingin Arabic

Writing and readingin English

High School

University Stage

Vocational Training

Certi�cate Graduation Year

Employability Skills

Speaking English

General Job Skills Evidence of Skills ?How does the jobseeker describe his skills?

Social Media(Twitter, Facebook,

Instagram, Snapchat)

Internet Excellent Good Beginner I can’t

E-mail Excellent Good Beginner I can’t

Excellent Good Beginner I can’t

Computer skills How does the jobseeker describe his skills? Evidence of Skills ?

Microsoft Word Excellent Good Beginner I can’t

Microsoft Excel Excellent Good Beginner I can’t

Microsoft PowerPoint Excellent Good Beginner I can’t

Microsoft Access Excellent Good Beginner I can’t

Others Excellent Good Beginner I can’t

Ms O�ce Skills How does the jobseeker describe his skills? Evidence of Skills ?

General Health and WellnessConsiderations

Considered N/A Date

Yes No

Do you have a current medical report? Yes No

(PENA) Version: 8.0 - (25/10/2015)10

Occupational and Employment History

Length of Unemployment0-3 months

3-6 months

7-9 months

10-12 months

1-2 year

+ 2 years

Previous Work History

-

-

-

Yes No

Date From - To Job Title Employer

0

1 - 4

5-8

9-12 16-20

13-16 +20How many jobs did you apply for during the last 6 months?

Financial Transportation

No support/access

Distance

Other, specify

If you succeeded in an interview but refused the job that was o�ered state the reason

Have you received feedback after an interview in which you were not accepted?

What are the most recent interviews that you attended? (List up to 3)

Job Title Interviewer/ Employer

Working Hours

OtherQuali�cations Required?Work Experience Required?

11(PENA) Version: 8.0 - (25/10/2015)

Occupational and Employment History

Length of Unemployment0-3 months

3-6 months

7-9 months

10-12 months

1-2 year

+ 2 years

Previous Work History

-

-

-

Yes No

Date From - To Job Title Employer

0

1 - 4

5-8

9-12 16-20

13-16 +20How many jobs did you apply for during the last 6 months?

Financial Transportation

No support/access

Distance

Other, specify

If you succeeded in an interview but refused the job that was o�ered state the reason

Have you received feedback after an interview in which you were not accepted?

What are the most recent interviews that you attended? (List up to 3)

Job Title Interviewer/ Employer

Working Hours

OtherQuali�cations Required?Work Experience Required?

Future Plans – Hopes and Dreams

What are your hobbies and interests? Think about hobbies/interests that you enjoy such as playing football, cooking, photography

Is it possible to look for a job in the �eld or to use the skills in a di�erent way at work?

What is your dream job? Describe it to us

What are the challenges you think you face in gaining employment or entering the labour market?

(PENA) Version: 8.0 - (25/10/2015)12

Information related to Accommodations

Considered N/A Date

I would like to get a job with the following features – “specify”

Considerations for the suitable job

I may need some help to identify the job requirements – “specify”

Working at homeTeleworking

1. Standing

2. Walking

3. Sitting

4. Lifting

5. Carrying

6. Pushing

7. Climbing

8. Balance

9. Bending

10. Bowing

11. Manual Handling

12. Manual Dexterity

13. Visual

14. Auditory

15. Reading

16. Writing

17. Speaking & Oratory

18. Using numbers and/or money

19. Reading the time

20. Acting quickly

21. Working on set time and/or goals

22. High levels of concentration

23. Completing a variety of tasks

24. Remembering instructions

25. Using computers

FulltimePart-time

Job Requirements JS explains his needs Job Requirements JS explains his needs

IndoorsOutdoors “�eld”

O�ce/working in one placeRequires moving around

Working in a busy environmentWorking in a relaxed environment

Working in a hot environmentWorking in a cold environment

Doing one repetitive task Multitasking

Working in an only-men environment – or only-womenWorking in a semi-mixed environment

Wearing a uniformWithout wearing a uniform

Requires working aloneRequires working within a team

No transportationTransportation

13(PENA) Version: 8.0 - (25/10/2015)

Information related to Accommodations

Considered N/A Date

I would like to get a job with the following features – “specify”

Considerations for the suitable job

I may need some help to identify the job requirements – “specify”

Working at homeTeleworking

1. Standing

2. Walking

3. Sitting

4. Lifting

5. Carrying

6. Pushing

7. Climbing

8. Balance

9. Bending

10. Bowing

11. Manual Handling

12. Manual Dexterity

13. Visual

14. Auditory

15. Reading

16. Writing

17. Speaking & Oratory

18. Using numbers and/or money

19. Reading the time

20. Acting quickly

21. Working on set time and/or goals

22. High levels of concentration

23. Completing a variety of tasks

24. Remembering instructions

25. Using computers

FulltimePart-time

Job Requirements JS explains his needs Job Requirements JS explains his needs

IndoorsOutdoors “�eld”

O�ce/working in one placeRequires moving around

Working in a busy environmentWorking in a relaxed environment

Working in a hot environmentWorking in a cold environment

Doing one repetitive task Multitasking

Working in an only-men environment – or only-womenWorking in a semi-mixed environment

Wearing a uniformWithout wearing a uniform

Requires working aloneRequires working within a team

No transportationTransportation

N/A

Cognition (Understanding & Communication)

Mobility (Movement & Mobility)

Self-Care (hygiene, eating, independence)

Getting Along (Interation and integration with others

Life activities (household and personal responsibilities, entertainment, work and school)

Participation (participating in family and community activities)

Summary of Strengths

(PENA) Version: 8.0 - (25/10/2015)14

N/A

Cognition (Understanding & Communication)

Mobility (Movement & Mobility)

Self-Care (hygiene, eating, independence)

Getting Along (Interation and integration with others

Life activities (household and personal responsibilities, entertainment, work and school)

Participation (participating in family and community activities)

Summary of Employment Support Needs

N/A

Cognition (Understanding & Communication)

Mobility (Movement & Mobility)

Self-Care (hygiene, eating, independence)

Getting Along (Interation and integration with others

Life activities (household and personal responsibilities, entertainment, work and school)

Participation (participating in family and community activities)