2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question #1-W
Response sheet-Employment
List three things you can do on a job:
1. _____________________________________________________________
2. _____________________________________________________________
3. _____________________________________________________________
Question #2-W
Careers
Name three careers that interest you:
1. _____________________________________________________________
2. _____________________________________________________________
3. _____________________________________________________________
1
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Questions #3-W - #4-W - #5-W
Employment Application
3. Personal Information:
Name:
___________________________________________________________
Last
First
Address:
___________________________________________________________
Street
_______________________________ ____________ ________________
City
State
Zip Code
_____________________________________________
Phone
4. Education :
School
Location
Years completed
5. Work/Volunteer Experience:
Dates employed
Company
Location
Role/Title
2
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Questions #6-W - #7-W- #8-M
Employment Application
6. References: (People who know about your skills)
Name
Phone
Address
How long you
have known them
Relationship
7. Job Skills
List your work skills:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
8. Sign your application:
Signature:________________________________________________ Date:__________
3
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question #9-M
Schedule a Job Interview/Appointment
Test administrator will set up a role play scenario with the student. Assume the student has
submitted an application to WalMart for a job as a __________(choose an appropriate type
of job for the student’s interest and ability). The Test Administrator will pretend to be Mrs.
Smith and is calling the student to ask the student to come for an interview
“Hi,_________________(Student name). This is Mrs. Smith from Walmart.
Thank you for sending us your application. We would like for you to come in
for an interview on April 10, 2013 at 9:00 a.m. Can you come to my office at
this time?”
The student should consult the provided calendar to determine if that time is open on the
schedule.
My Calendar: April 7th - 13th
8:00
AM
9:00
Sunday
7
Monday
8
Tuesday
9
Wednesday
10
Haircut
Saturday
13
Clean
room
11:00
1:00
Friday
12
Shopping
10:00
12:00
PM
Thursday
11
Watch
movie
with
friends
Lunch with
Aunt Sue
2:00
3:00
4:00
5:00
Dentist
Dinner
with
Family
4
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Use the information from the paragraph and calendar above to fill in the
blanks.
My interview with Mrs. Smith at Walmart is scheduled for
_____________________ (date) at ____________________________(time).
Question #10-R
Determine Arrival Time
Test Administrator may provide a clock or manipulative.
9. Read the paragraph and answer the question below.
It is important to be on time for an interview. My interview with Mrs.
Smith is at 9:00 A.M. I need to plan what time I need to arrive at my
interview. I know it is about 20 minutes from my home. Employers
like it when I am 15 minutes early for my interview. I will arrive for
my interview at 8:45 a.m. This will let my employer know I can be on
time for work.
I will arrive for my interview at ___________________________
(time)
a. 9:15 A.M.
b. 8:30 P.M.
c. 8:45 A.M.
Question #11-R
Appropriate Clothing for an Interview
Use Teacher-Provided Materials/pictures to discuss appropriate dress for an
interview
5
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Questions #12-R - #13-R
Interview Communication Skills
*The Test Administrator is asked to set up a mock interview situation. It is preferable to use a
person with whom the student is not closely associated on a daily basis. Test Administrator will
observe and score student responses according to the Level of Independence rubric.
12. When the student met the interviewer, did he/she
Communicate a greeting:
a. Handshake
b. Verbal Greeting
c. Appropriate Body Language (eye contact, smile, personal space)
•
13.
Prepare the interviewer to ask the student some natural questions related to the type of
job the student is interviewing for during the mock interview. The interviewer may
adapt the questions.
Sample interview questions:
1. Tell me why you would like to work as a __________________________?
2. Tell me about your work skills.
3. How will you plan to get to work each day?
6
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question #14-R
Following Directions for a Job Task
•
•
The Test Administrator will create an appropriate three-step procedure related to a job
task using text/picture/ symbol cards or checklist.
Score student responses
Question # 15-M
Using classroom/Internet/printed resources, student will search for information related to an
average monthly income for a chosen career/job. Amounts may be estimates.
The job I like is _____________________________________.
An average monthly income for this job is $_________________.
Question # 16-M
Using an estimated average monthly income, student will determine the possible
gross weekly salary related a chosen career/job.
This job pays about $_________ per hour.
In one day, if I work 8 hours, I can earn $___________.
If I work 5 days in a week, I can earn $____________.
In a month (4 weeks), I could earn $_____________from my job.
7
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 17-M-18-W
Using an estimated average monthly income, student will develop a monthly
budget to include housing, food, personal items, clothing and recreation.
My Monthly Budget
When I plan how to spend my money each month, I estimate that:
I will earn about $_________ a month.
My rent for a room/apartment is $____________ a month.
I can spend $______________ a month for food I buy at the grocery store or go
out to eat in a restaurant.
I can spend $__________ a month for clothes.
I can spend $____________ a month for things I need, like toothpaste, shampoo
or cleaning supplies.
I can plan to spend $_____________ on going out for fun.
Money earned
Housing
Food
Clothes
Personal Items
Recreation
Income
Expense
8
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 19-R
Using a graphic, student will read/identify five major food groups.
Question # 20-M
Using the charts and information on http://www.choosemyplate.gov or other
similar information source, identify how many servings are recommended each
day from each food group
To be healthy, I should plan to eat foods from each group every day. Write the
number of servings needed each day.
Protein
Vegetables
Fruit
Grain
Dairy
9
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 21-W
Menu Plan
Using the food plate graphic and information from the Internet sites in Question
#20, or other resource, plan a menu for one meal using the food plate.
My menu plan is for (choose one)
Breakfast
Lunch
Dinner
Choose the foods you want to eat for one meal and write it in the chart:
Protein
Vegetables
Fruit
Grain
Dairy
Breakfast
Lunch
Dinner
Number of
servings for
this meal
Question # 22-W
Shopping List for Menu Plan
The student will prepare a shopping list related to the planned menu in
Question 21
Shopping List
To prepare my meal, I will need to shop for these items:
Vegetables
Fruit
Meat
Dairy
Grains
Other
10
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 23-M
Price Comparison
The student will compare the cost of two brands of one item and determine the
brand with the lowest cost.
When I go shopping at the grocery store for ____________________________,
(choose an item from the shopping list)
I find two different brands. Which one has the lowest cost?
Brand One: ______________________________ Cost: ________________
Brand Two: ______________________________ Cost: ________________
Lowest Cost Brand: __________________________________
Question # 24-M
Estimated Total Cost
Student will estimate the total cost of five items on shopping list of at least five
items.
Choose five items from your shopping list. Estimate the cost of each item and
round to the nearest dollar. Find the total cost.
Price of Item 1:
________________
Price of Item 2:
________________
Price of Item 3:
________________
Price of Item 4:
________________
Price of Item 5:
________________
Estimated Total Cost: __________________
11
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 25-M
Purchasing Items
Student will demonstrate how to purchase item(s) using only bills.
Question # 26-M
Purchasing Items
Student will demonstrate how to purchase item(s) using a combination of bills and
coins.
Question # 27-M
Coupon Savings
Student will determine the cost of one item using a coupon.
Item Cost: ______________________
Coupon Discount: _______________
Cost of item after coupon: __________________________________
Question # 28-R
Ask for Assistance
Student will ask for assistance one time related to a shopping experience.
When I am shopping, sometimes I have a question about an item. How can I ask
for help?
I could say, “ ________________________________________________________
__________________________________________________________________”
12
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 29-R
Community Leisure Activity
Student will use resource materials to find the location and hours of operation for
one leisure activity in the community.
For fun, I would like to go to ________________________________.
It is located at ___________________________________________________
It opens at _____________o’clock and closes at _________ o’clock.
Question # 30-W
Create a Weekly Schedule
Student will create a weekly schedule with at least two activities.
Day
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Date
_____
_____
_____
_____
_____
_____
_____
8:00
AM
9:00
10:00
11:00
12:00
PM
1:00
2:00
3:00
4:00
5:00
13
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 31-R and #32-M
Plan Transportation
Student will plan transportation for at least one activity on the weekly schedule.
31. When I go to _____________________________________________ I will
use a_______________________________.
32. It will cost $_________________________.
14
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question # 33-R
Common Community Signage Symbols -Teacher List
The student will identify 10 common community signage symbols (environmental
print).
Test Administrator will choose 10 from the list that are the most appropriate for
student and cut apart 10-15 pictures from which the student may choose. The
number of choices presented at one time can vary.
Poison
Wet Paint
Recycle
Trash
Women’s Restroom
Keep Out!
Yes…We Are Open
Don’t Walk
Stop
Bus Stop
Beware of Dog
Railroad Crossing
Phone
Airport
Bike Route
No Bicycles
Buckle Up for Safety
Fire Station
School Crossing
No Parking
Signal Ahead
No Pets
Escalator
First Aid
Wet Floor
Fire Extinguisher
Men’s Restroom
No Soliciting
Out of Order
Sorry…We Are Closed
Watch Your Step
Exit
Hospital
Speed Limit
No Diving
Walk/Don’t Walk
No Trespassing
Slippery When Wet
Wash Hands
Water Fountain
Do Not Enter
High Voltage/Danger
Keep Off the Grass
No Swimming
Yield
Elevator
Fire Extinguisher
No Food/ No Drink
15
2012-2013
11th Grade Alternate Assessment Optional Worksheets
16
2012-2013
11th Grade Alternate Assessment Optional Worksheets
17
2012-2013
11th Grade Alternate Assessment Optional Worksheets
18
2012-2013
11th Grade Alternate Assessment Optional Worksheets
19
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question #34-R
The student will identify two emergency situations in the community services in
the community.
34. If I need help, I could call ____________________________
and ________________________________________________.
Question #35-R
Possible Emergency Situations
Student will choose three emergency situations from the list below and describe
an appropriate response to the situation.
Bee Sting
Emergency weather siren
Fire
Drowning
Trouble breathing
Smell gas
Power outage
Clothing on fire
Snowed in and don’t have
medication
Someone breaking into your house
Dog bite
Cut to the body
Burn on the body
Take too much medication
What to do when the toilet
overflows
How to keep warm if there is no
heat
20
2012-2013
11th Grade Alternate Assessment Optional Worksheets
Question #36
Personal Contact List
Name
Phone Number
Address
Mom
Dad
Grandparent
Case Worker
Neighbor
Doctor
Dentist
Poison Control
21