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Select the appropriate answer to the following questions based on your ability to perform the duties of this position. When answering the questionnaire, remember that your answers are subject to verification by investigation. You may be asked to provide specific examples or documentation of your knowledge or skills as proof to support your answers, or you may be required to verify a response by a practical demonstration of your claimed ability to perform a task. Please select only one letter for each item.
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For each item, select the one response that most accurately describes your current level of experience and capability using the scale below.
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SCREEN OUT ELEMENT: From the descriptions below, choose the statement that best describes the highest level of experience that you possess and that demonstrates your ability to perform the duties of a Housekeeping Aid as described in the duties section of the announcement without more than normal supervision. This is a screen-out element. Failure to meet a minimum level will result in an ineligible rating. Select only ONE letter.
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ASSESSMENT QUESTIONNAIRE - For each task in the following groups, choose the statement from the list below that best describes your experience and/or training.
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Special Aptitude (Housekeeping Work):
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Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.
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Using proper cleaning solutions and/or chemicals to successfully remove stains from a variety of surfaces (floors, carpet, tile, walls, etc.)
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Applying appropriate cleaning solutions to various types of floors (linoleum, wood, or marble), walls, and ceilings to clean and maintain such surfaces.
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Cleaning patients' rooms using sanitizing chemicals that will not compromise patients' health to disinfect surfaces.
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Work Practices (Including Keeping Things Neat, Clean, and in Order):
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Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.
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Cleaning and sanitizing restrooms: urinals, commode, sink, mirror, etc.
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Taking care of a house doing work such as cooking, washing clothes, sweeping, mopping, washing dishes.
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Ability to Interpret Instructions:
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Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.
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Removing soiled linen from ward areas or clinics using the proper collection methods for handling possible contaminated items.
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Following sanitation and infection control procedures to prevent the spread of bacteria.
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Selecting proper equipment to clean floors, carpet, drapes, and light fixtures.
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Reading and following posted instructions through signs and pictures.
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Following simple written instructions for completing non-routine cleaning tasks.
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Following oral directions to perform simple tasks which may require several steps to complete.
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Ability to Use and Maintain Tools and Equipment:
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Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.
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Keeping a stock of cleaning materials and equipment needed to do your work.
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Operating powered equipment such as scrubbing machines, buffers, carpet cleaning machines and/or industrial vacuums.
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Keeping equipment, cords, hoses, etc., clean and properly stored when not in use.
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Using ladders and/or scaffolds to wash ceiling fixtures; washing or replacing venetian blinds, or room partitions.
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Performing routine maintenance on cleaning equipment such as changing filters and brushes on vacuum cleaners and floor buffers.
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Performing routine maintenance on cleaning equipment such as tightening nuts and bolts and/or greasing/oiling fittings and wheels.
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Dexterity and Safety:
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Select the one statement that most accurately describes your training and experience carrying out each task using the scale provided.
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Pushing, pulling, lifting, carrying or moving cleaning equipment around for several hours or more at a time.
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Standing/walking for several hours or more while cleaning and moving furniture.
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Sweeping and mopping floors repetitively in high traffic areas such corridors, restrooms, stairways, entryways, cafeterias and other areas.
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Emptying trashcans at various locations several times a day.
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Adhering to safety policies and procedures when performing manual work.
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Working quickly without accidents while at the same time being attentive to the quality of your work.
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Recognizing typical health and safety hazards for yourself and other workers around you.
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Working rapidly and accurately under the pressure of deadlines.
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Using proper lifting techniques when lifting objects especially those that may be bulky and/or awkward.
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I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled; I may be denied an appointment; or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated and that responding "No" or providing no response to this item will result in my not being considered for this position.
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RESUME REMINDER - Your resume must include the following information each job listed: Job title Duties (be as detailed as possible) Month & year start/end dates (e.g. June 2007 to April 2008) Full-time or part-time status (include hours worked per week)
Please be aware that your answers will be verified against information provided on your resume. Be sure that your resume clearly supports your responses to all of the questions by addressing your work experience in detail.
Recommended: Even though we do not require a specific resume format, your resume must be clear so that we are able to fully evaluate your qualifications. To ensure you receive appropriate consideration, please list the duties you performed under each individual job title. If we are unable to match your experiences with the positions held, you may lose consideration for this vacancy. We cannot make assumptions regarding your qualifications.
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MERIT PROMOTION DOCUMENTATION REMINDER - If you are a current or former Federal employee, you must provide a copy of your last or most recent SF-50, "Notice of Personnel Action." The SF-50 must identify your position, title, series, grade, step, tenure, and type of service (Competitive or Excepted). If you have previously held a higher grade and are applying based on that grade, you must provide a copy of the SF-50 showing you held the higher grade IN ADDITION to your last or most recent SF-50 indicating proof of status.
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VETERANS PREFERENCE DOCUMENTATION REMINDER - You must submit proper documentation if you are claiming eligibility for veterans preference, which includes a copy of your DD-214 (member copy 4 or earlier version that shows character of service). Applicants claiming 10-Point preference should also submit an SF-15, Application for 10-Point Veterans Preference along with the required documentation listed on the form (such as verification of service-connected disability percentage).
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