Sample Job Analysis Questionnaire
A. POSITION INFORMATION

Job Title: Job Code:

Department: Division:

B. GENERAL PURPOSE OF POSITION

Indicate in a few sentences the general purpose of the position (or why this job exists). This statement should be a general summary of the responsibilities listed in the next section.

C. SUMMARY OF RESPONSIBILITIES/DUTIES

Describe specific job responsibilities/duties. Give a best estimate of average percentage of time each responsibility takes; however, do not include a duty which occupies 5% or less of your time unless it is an essential part of the job. Each statement should be brief and concise, beginning with an action verb. A list of action verbs is attached for reference but feel free to use other action verbs if they are more appropriate. The box below shows an example.

| --EXAMPLE-- | Percent (%) |
| |of Time |
|Secretary | |
|1. Performs a variety of typing duties including standard letters, reports and forms. | |
|2. Takes and transcribes dictation. Composes letters and memos as directed. |25% |
|3. Maintains departmental files; ensures that all records are updated and modified as necessary. |25% |
|4. Answers the telephone and greets visitors. |20% |
|5. Makes travel arrangements. |20% |
| |10% |
| |100% |
| | LIST MOST IMPORTANT DUTIES FIRST | |Percent (%) |
| | | |of Time |
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| | | |100% |

For the remainder of the questionnaire, most of the questions require that you check the box or list information. Guidelines for completing these sections are as follows: 1) read each definition carefully before answering, 2) consider the job, not yourself, 3) answer based on the job as it currently exists, 4) select the most appropriate answer(s) for each question.

General Education & Experience

D. EDUCATION: Check the box that best indicates the minimum training/education requirements of this job. (Not necessarily your education, but the requirements for the job).

Minimum Requirement [pic] Up to 8 years of education [pic] Some College/Associate's Degree

[pic] 9 to 11 years of education [pic] Bachelor's Degree

[pic] High School Diploma or GED [pic] Master's Degree

[pic] Vocational/Technical/Business School [pic] Doctorate Degree

E. EXPERIENCE

TYPE OF EXPERIENCE NEEDED: Please indicate the specific job experience needed. For example, "accounting experience in an education environment" vs. "accounting experience". Be sure that the experience stated is what is actually required by the job, not what is preferred.

Check the box which best indicates the minimum amount of experience described above. (Not necessarily your years of experience, but the requirements for the job.)

[pic] Less than 6 months [pic] 3 but less than 5 years [pic] 6 months but less than 1 year [pic] 5 but less than 7 years [pic] 1 year but less than 3 years [pic] 7 years plus

F. TYPE OF SKILLS AND/OR LICENSING/CERTIFICATION REQUIRED:

Please indicate all specific skills and/or licensing/certification required (not preferred) to do this job. For example, spreadsheet software proficiency may be a requirement for a secretarial job; journey license may be required for an electrician.

G. SUPERVISORY RESPONSIBILITIES

SUPERVISORY NATURE: What is the nature of the direct supervisory responsibility your job has? Check one answer.

|[pic] |No supervisory responsibility. |
|[pic] |Work leadership of one or more employees. |
|[pic] |Supervisor over a section of a department. |
|[pic] |Assistant Manager over supervisors or a small department. |
|[pic] |Manager of one department. |
|[pic] |Manager of more than one department. |
|[pic] |Director, through managers, of a single department. |
|[pic] |Director, through managers, of multiple departments. |

How many positions report directly to you?

[pic] None [pic] 1 [pic] 2-3 [pic] 4-6 [pic] 7 or more

List the title(s) of employee(s) whom you directly supervise:
|Title | |Grade/Level | |Number of Positions |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |

Indicate the total number of employees you indirectly supervise through supervisors or managers:

[pic] None [pic] 1-5 [pic] 6-10 [pic] 11-20 [pic] 21-50 [pic] 51-100 [pic] 100 +

Does this position require functional supervision of positions that do not report directly to you?

[pic] Yes [pic] No

H. PHYSICAL DEMANDS AND WORKING CONDITIONS

Indicate how often the following physical demands are required to perform the Essential Job Responsibilities.

C=Constantly F=Frequently O=Occasionally R=Rarely (5-8 hrs./shift) (2-5 hrs./shift) (Up to 2 hrs./shift) (Does not exist as regular part of job)

|Physical Demands | | |Environmental Conditions | |
|Standing | | |Extreme Cold | |
|Walking | | |Extreme Heat | |
|Sitting | | |Temperature Changes | |
|Lifting | | |Wet | |
|Carrying | | |Humid | |
|Pushing | | |Noise | |
|Pulling | | |Vibration | |
|Climbing | | |Hazards | |
|Balancing | | |Atmospheric Conditions | |
|Stooping | | |Other (define): | |
|Kneeling | | | | |
|Crouching | | | | |
|Crawling | | | | |
|Reaching | | |Physical Strength | |
|Handling | | |Little Physical Effort | |
|Grasping | | |Light Work | |
|Feeling | | |Medium Work | |
|Talking | | |Heavy Work | |
|Hearing | | |Very Heavy Work | |
|Repetitive Motions | | | | |
|Eye/Hand/Foot Coordination | | | | |

I. GENERAL COMMENTS

Because no single questionnaire can cover every part of a job, can you think of any other information that would be important in understanding this position? If so, please describe.

Employee's Name: Title:

Employee's Signature:

Date: Telephone Number:

J. SUPERVISOR'S REVIEW SECTION

Based on your understanding of the job as it currently exists, please review the employee's response and provide your own comments in the space provided below. Please do not change the employee's responses.

The questionnaire is intended to analyze the job as it is currently being done and not how it might be done in the future. The employee's level of performance in the job is not part of this review and is not to be considered.
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|Section | |Remarks |
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Supervisor's Name: Title:

Supervisor's Signature: Date:

Telephone Number:

K. REVIEWING OFFICIAL'S REVIEW SECTION

Based on your understanding of the job as it currently exists, please review the employee's response and provide your own comments in the space provided below. Please do not change the employee's or supervisor's responses.

The questionnaire is intended to analyze the job as it is currently being done and not how it might be done in the future. The employee's level of performance in the job is not part of this review and is not to be considered.

|Section | |Remarks |
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Reviewing Official's Name: Title:

Reviewing Official's Signature: Date:

Telephone Number:
This questionnaire is to be forwarded next to your division administrator.

Division administrator, please initial to indicate review ____________.
(Attach additional page(s) for clarifying comments, as necessary.) ACTION VERBS ATTACHMENT

This list of action verbs should be used to assist you in completing the Summary of Responsibilities section. These verbs are useful in identifying and defining job functions. Although many of the terms may seem obvious, definitions are provided in the interest of consistency.

Administer—Manage or direct the execution of affairs.
Adopt—Take up and practice as one's own.
Advise—Recommend a course of action; offer an informed opinion based on specialized knowledge
Analyze—Separate into elements and critically examine.
Anticipate—Foresee and deal with in advance.
Appraise—Give an expert judgement of worth or merit.
Approve—Accept as satisfactory; exercise final authority with regard to commitment of resources.
Arrange—Make preparation for an event; put in proper order.
Assemble—Collect or gather together in a predetermined order from various sources.
Assign—Specify or designate tasks or duties to be performed by others.
Assume—Undertake; take for granted.
Assure—Give confidence; make certain of.
Authorize—Approve; empower through vested authority.
Calculate—Make a mathematical computation.
Circulate—Pass from person to person or place to place.
Clean—To remove dirt or make tidy.
Clear—Gain approval of others.
Collaborate—Work jointly with; cooperate with others.
Collect—Gather.
Compile—Put together information; collect from other documents.
Concur—Agree with a position, statement, action, or opinion.
Conduct—Carry on; direct the execution of.
Confer—Consult with others to compare views.
Consolidate—Bring together.
Construct—Build, make or modify.
Consult—Seek the advice of others.
Control—Measure, interpret, and evaluate actions for conformance with plans or desired results.
Coordinate—Regulate, adjust, or combine the actions of others to attain harmony.
Correlate—Establish a reciprocal relationship.
Correspond—Communicate with.
Debug—To detect, locate and remove mistakes from a routine of malfunctions from a computer.
Delegate—Commission another to perform tasks or duties that may carry specific degrees of accountability.
Deliver—Carry to intended destination.
Design—Conceive, create, and execute according to plan.
Determine—Resolve; fix conclusively.
Develop—Disclose, discover, perfect, or unfold a plan or idea.
Devise—Come up with something new, perhaps by combining or applying known ideas or principles.
Direct—Guide work operations through the establishment of objectives, policies, rules, practices, methods, and standards.
Discuss—Exchange views for the purpose of arriving at a conclusion.
Dispose—Get rid of.
Disseminate—Spread or disperse information.
Distribute—Deliver to proper destinations.
Draft—Prepare papers or documents in preliminary form.
Endorse—Support or recommend.
Establish—Bring into existence.
Estimate—Forecast future requirements.
Evaluate—Determine or fix the value of.
Execute—Put into effect or carry out.
Exercise—Exert.
Expedite—Accelerate the process or progress of.
Formulate—Develop or devise.
Furnish—Provide with what is needed; supply.
Implement—Carry out; execute a plan or program.
Improve—Make something better.
Initiate—Start or introduce.
Inspect—Critically examine for suitability.
Install—To set up for use.
Interpret—Explain something to others.
Investigate—Study through close examination and systematic inquiry.
Issue—Put forth or to distribute officially.
Maintain—Keep in an existing state.
Monitor—Watch, observe, or check with an eye to reaching agreement.
Notify—Make known to.
Operate—Perform an activity or series of activities.
Participate—Take part in.
Perform—Fulfill or carry out some action.
Place—Locate and choose position for.
Plan—Devise or project the realization of a course of action.
Practice—Perform work repeatedly in order to gain proficiency.
Prepare—Make ready for a particular purpose.
Proceed—Begin to carry out an action.
Process—Subject something to special treatment; handle in accordance with prescribed procedure.
Promote—Advance to a higher level or position.
Propose—Declare a plan or intention.
Provide—Supply what is needed; furnish.
Recommend—Advise or counsel a course of action; offer or suggest for adoption.
Repair—Fix or make usable.
Represent—Act in the place of or for.
Report—Give an account of; furnish information or data.
Research—Inquire into a specific matter from several sources.
Review—Examine or re-examine.
Revise—Rework in order to correct or improve.
Schedule—Plan a timetable.
Secure—Gain possession of; make safe.
Select—Choose the best suited.
Sign—Formally approve a document by affixing a signature.
Sort—To separate or arrange according to a plan.
Specify—State precisely in detail or name explicitly.
Stimulate—Excite to activity; urge.
Submit—Yield or present for the discretion or judgement of others.
Supervise—Personally oversee, direct, inspect, or guide the work of others with responsibility for meeting standards of performance.
Train—Teach or guide others in order to bring up to a predetermined standard.
Transcribe—Transfer data from one form of record to another or from one method of preparation to another, without changing the nature of the data.
Verify—Confirm or establish authenticity; substantiate.
Write—To compose or draft.