Job Questionnaire

Name: _____________________________________
_____________________________
Department: ________________________________
__________________________
Supervisors Name: ___________________________
______________________

Job Title:
Job Number:
Supervisors Title:

1. SUMMARY OF DUTIES: State in your own words briefly your main duties. If you
are responsible for filling out reports/records, also complete Section 8.
____________________________________________________________________________
____________________________________________________________________________
2. SPECIAL QUALIFICATIONS: List any licenses, permits, certifications, etc.
required to perform duties assigned to your position.
____________________________________________________________________________
____________________________________________________________________________
3. EQUIPMENT: List any equipment, machines, or tools (e.g., typewriter,
calculator, motor vehicles, lathes, fork lifts, drill presses, etc.) you normally
operate as a part of your positions duties.
MACHINE
AVERAGE NO.
HOURS PER WEEK
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. REGULAR DUTIES: In general terms, describe duties you regularly perform.
Please list these duties in descending order of importance and percent of
time spent on them per month. List as many duties as possible and attach
additional sheets, if necessary.
___________________________________________________________________________
___________________________________________________________________________
5. CONTACTS: Does your job require any contact with other department
personnel, other departments, outside companies or agencies? If yes, please
define the duties requiring contacts and how often.
__________________________________________________________________________
__________________________________________________________________________
6. SUPERVISION: Does your position have supervisory responsibilities? ( ) Yes ( )
No.
If yes, please fill out a Supplemental Position Description Questionnaire for
Supervisors and attach it to this form. If you have responsibility for the work
of other but do not directly supervise them, please explain.

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
7. DECISION MAKING: Please explain the decisions you make while performing
the regular duties of your job.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(a) What would be the probable result of your making (a) poor judgement(s)
or decision(s), or (b) improper actions?
__________________________________________________________________________
__________________________________________________________________________
8. RESPONSIBILITY FOR RECORDS: List the reports and files you are required to
prepare or maintain. State, in general, for whom each report is intended.
(a)
REPORT
INTENDED
FOR
_________________________________________________________________________
_________________________________________________________________________
(b)

FILES MAINTAINED

_________________________________________________________________________
_________________________________________________________________________
9. FREQUENCY OF SUPERVISION: How frequently must you confer with your
supervisor or other personnel in making decisions or in determining the
proper course of action to be taken?
( ) Frequently
( ) Occasionally
( ) Seldom
( ) Never
10. WORKING CONDITIONS: Please describe the conditions under which you work
inside, outside, air conditioned area, etc. Be sure to list any disagreeable or
unusual working conditions.
_________________________________________________________________________
_________________________________________________________________________
11.JOB REQUIREMENTS: Please indicate the minimum requirements you believe
are necessary to perform satisfactorily in your position.
(a) Education
Minimum schooling: ___________________________________________________
Number of years: ______________________________________________________
Specialization or major: _________________________________________________
(b) Experience
Type: _______________________________________________________________
Number of years: _____________________________________________________
(c) Special Training
TYPE
NUMBER OF
YEARS

____________________________________________________________________
____________________________________________________________________
(d) Special Skills
Typing: ________________ w.p.m
Shorthand: _____________________ w.p.m
Other: ______________________________________________________________
12.ADDITIONAL INFORMATION: Please provide additional information, not
included in any of the previous items, which you feel would be important in a
description of your position.
_______________________________________________________________________
_______________________________________________________________________

___________________________
EMPLOYEES
NAME and SIGNATURE
DATE
________________

BACKGROUND DATA
FOR JOB DESCRIPTION

Job Title ________________________

____________________________
Job Number _____________________
_____________________________
Todays Date ____________________
____________________

I.

Department
Written by
Applicable DOT codes

Applicable DOT Definitions (s):

II. Job Summary:

(List the more important or regularly performed tasks)

III. Reports to:

IV. Supervises:

V. Job Duties: _______________________________________________________________

(Briefly describe, for each duty, what employee does and, if possible, how
employee does it. Show in parentheses at end of each duty the approximate
percentage of time devoted to duty.)
A. Daily Duties:

B. Periodic Duties:
(Indicate whether weekly, monthly, quarterly, etc.)

C. Duties Performed at Irregular Intervals: