Donnoe & Associates, Inc.

tel: 916.928.4911 toll free: 877.22.EXAMS fax: 916.928.0911

Other Assessors Questionnaire

This questionnaire will assist us to place you on a panel within the examination commensurate with your current work assignment, and in balance with the qualifications of the other assessors. Please answer all questions, then submit this form to Donnoe & Associates.

Items marked with * are required to process this form correctly.
 
Examination Title and Agency:
 
Examination Date:

Please type your name, rank, and agency, as you wish it to appear on your identification card at the examination. Also, for our records, please provide your mailing address and telephone numbers.

*
Name:
 
Rank:
 
Agency:
 
Mailing Address:
*
Work Telephone:
 
Fax:
 
Cell/Pager:
 
Home or Message:
*
E-mail Address:
 
Have you provided examination preparation services to candidates outside of your own agency for a fee?
 
If yes, when and where did you last do this?
 
Please check the box next to each item below for which you will request reimbursement.
To the extent possible, the agency wishes that each panel be balanced by ethnicity. It is for this reason that we are asking you to please respond to the following question.
 
Which of the following best describes your gender and ethnicity?
Once we have received this questionnaire from you, we will confirm your position on the examination panel and forward final instructions regarding when and where to report. By serving as an assessor for this examination you agree that you will not disclose any confidential testing information to any person, prior to, during, or after the examination. You are further agreeing to not use the information from this examination to prepare future candidates for this agency or other agencies, or inform candidates about the examination process. Thank you again for agreeing to participate as an assessor.