XRCVC EMPLOYMENT DATABASE QUESTIONNAIRE (ADVANCED)

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Type of Visual Impairment (Total/ Partial/ None):

 

Nature of Visual Impairment (From Birth/ Late; if late, in what year):

 

Cause of Visual Impairment:

 

 

Contact Details

 

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Office:

 

Telephone

 

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Professional

 

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Current Employer:   

 

 

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Income (optional):

 

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Remarks

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Instances of specific modifications made for effective integration into work 
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