Human Resources (last revised 1/2019) Page 3
Staff Position Questionnaire
(Job Description)
Part III: Knowledge and Skill Requirements
A. EDUCATION & EXPERIENCE
Estimate the minimum requirements of education and experience necessary for an individual to be considered for this position,
then list any preferred/desired qualifications.
2. Years and Type of Work Experience
3.
Certifications, Licenses and/or Specialized Technical Knowledge
Part IV. Americans with Disabilities Compliance Assessment of Job Requirements
Physical Demands (ADA Compliance)
A. GENERAL: How much on-the-job time is spent in the
following physical activities? Show the amount of time by clicking
or placing an “X” in the appropriate boxes below.
B. LIFTING: Does this position require that weight is lifted or force
is exerted? If so, how much and how often? Click or place an “X” in
the appropriate boxes below.
Stand
Walk
Sit
Talk or hear
Use hands/to handle/feel
Climb or balance
Stoop/kneel/crawl
Reach with arms
Taste or smell
Amount of Time
None Up to 1/3 1/3 - 2/3 2/3 +
Up to 10 pounds
Up to 25 pounds
Up to 50 pounds
Up to 100 pounds
More than 100
pounds
Amount of Time
None Up to 1/3 1/3 - 2/3 2/3 +
C. VISION: Does this position have any special vision requirements? Check all that apply.
Close Vision (clear vision at 20 inches or less)
Distance Vision (clear vision at 20 feet or more)
Color Vision (ability to identify and distinguish colors)
Peripheral Vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point)
Depth Perception (three-dimensional vision, ability to judge distances and spatial relationships)
Ability to Adjust Focus (ability to adjust the eye to bring an object into sharp focus)
No Special Vision Requirements
D. OTHER: Please list any other physical demands of the position.
For Human Resources Use Only (Please Do Not Write Below This Line)
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