1. GeneralIntake DateAuto-fills GeneralSocial Security NumberEnter – no punctuation. Double click for pseudo when needed GeneralFirst NameFree form text GeneralLast NameFree form text GeneralDate of BirthUse mmddyyyy format GeneralGenderSelect from drop down GeneralJob MatchClick for drop down to select ACTIVE when Job Match is INACTVE. GeneralLegally entitled to work in the ?Click to select – must be YES to SAVE. General/AdditionalMilitary Service?Click > YES or NO If YES, then complete a Veteran Validation AdditionalDates of Service (Veteran Validation) Click >Veteran Validation – answer the questions as they appear in the pop-up boxes. * AdditionalService Connected - Disability?When YES, % entered when validated AdditionalDisabled?Must be YES, NO, or NOT DISCLOSED to SAVE GeneralStaffAuto-fills with the staff logged into the system GeneralStaff OfficeAuto-fills with the office of the staff logged into the system GeneralEthnicityClick to select from drop down. GeneralRaceClick to select. GeneralEmployment StatusSelect from drop down. When employed, hours are required. GeneralESD Shared InformationClick to select YES or NO. When NO, non-ESD staff will not be able to view the record. AdditionalHighest grade of school completed?Click to select from drop down. AdditionalAttained certificate of Attendance/Completion Click > YES or NO. Used if the participant with a disability receives a certificate of attendance as a result of successfully completing an Individual Education Plan (IEP). AdditionalSeasonal/Farm workerClick > YES or NO AdditionalIn School?When YES, use the drop down to select the SCHOOL TYPE. When NO, use the drop down to select YES or NO to “Dropped out of High School?” AdditionalPublic Assistance Recipient?Click > YES or NO. When YES, click to select TYPE of Public Assistance. Program DataOffender?Click to select YES or NO. Program DataHomeless/Runaway?Click to select YES or NO. Preliminary Assessment This is also known as the Initial Assessment or Full SKIES Registration. It contains the following 54 data fields. Bolded items required to SAVE the record. SCWDC WS-06-05 Revised 06/21/2012 Page 1

2. GeneralMailing AddressStreet address auto-fills with Mailing address if a Street Address is not entered. GeneralPhone NumberUse xxxxxxxxxx format. GeneralE-mailMust have an @ and a (dot) domain AdditionalDriver’sClick to select from a drop down. AdditionalLicense ClassClick to select from a drop down. AdditionalEndorsementsClick to select. Desired EmploymentO*NET CodeUse AutoCoder. Months ExperienceWhen no experience, enter 0. Desired EmploymentLast Year WorkedUse yyyy format Desired EmploymentDesired LocationAuto-fills from Address. Click to select additional Counties. Click to unselect the. Or, click to select Statewide. Or, click to select Anywhere. Employment HistoryEmployer NameFree form text. Employment HistoryO*NET Code (O*NET Title and Job Title auto-fill with O*NET selection) Use AutoCoder Employment HistorySalary$ not necessary Employment HistoryIntervalClick to select from drop down list. Employment HistoryHours/WeekEnter the average number of hours worked per week. Employment HistoryStart Date – End DateEnter using mmyyyy format Employment HistoryReason for LeavingNot required when Reason for Leaving is “Still Employed” Assessment Initial Employment Employment Issues Job Behavior Patterns  Work history?  Reasons for leaving the last job?  Gaps in employment? Stable work history  Same job over X years?  Still employed?  Layoff or closure?  Same industry for years? Unstable work history  Terminated from last 2 jobs  Gaps in employment?  No recent work history  Work limitations?  Frequent job changes? Preliminary Assessment Continued SCWDC WS-06-05Revised 06/21/2012 Page 2

3. Assessment Initial Employment Employment Issues Job Seeking Skills  Do you have a resume?  Where are you posting your résumé?  Do you have a network to help find work?  How have you found work in the past?  What is your biggest challenge in looking for work?  What kind of response have you had from your résumé?  When was your last interview?  What skills do you have for the job you are seeking?  What job search techniques do you use? Assessment Initial Employment Employment Issues Summary of Occupational Strengths and Weaknesses Summarize the information collected to begin the Service(s) Plan justification – workshop, GED, referral to assessment, preparation for Intensive Services. Use CIRY Model. Assessment Initial Employment Employment Issues LMI vs Potential Earnings  Is the demand for your skills growing or in decline?  Do you know the prevailing wage for your occupation?  Do you believe you will get the previous wage earned?  Is the Job Seeker familiar with Workforce Explorer or other labor market research tools?  Are Job Seeker skills in demand at a given wage?  Verify demand or decline occupation. Assessment Initial Employment Employment Issues Does the Seeker have the ability to identify an employment goal? Click > YES or NO. Assessment Initial Employment Desired Employment Is Seeker interested in non- traditional employment? Click > YES or NO. Assessment Initial Employment Desired Employment Employment ObjectiveWhat result does the Job Seeker want/need? Assessment Initial Employment Ed Issues Seeker’s Primary Language? Click to select from drop down list. Assessment Initial Employment Ed Issues Is Seeker’s English speaking ability limited? Click to select YES or NO. Assessment Initial Employment Ed Issues Does Seeker lack basic education skills? Click to select YES or NO. Assessment Initial Employment Ed Issues Training Plans not completed Free form text Assessment Initial Employment Ed Issues Interests, Aptitudes, and need for more training Free form text Preliminary Assessment Continued SCWDC WS-06-05 Revised 06/21/2012Page 3