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FORM 4.04 QUESTIONNAIRE <br /> Suppliers shall complete this "Questionnaire" providing the information in the same order <br /> requested below. Suppliers may emphasize in their narrative any areas of their proposal that <br /> they believe exceed our requirements. <br /> 1. Qualifications and Relevant Experience <br /> A. Briefly describe your firm. Include how long the company been in business. <br /> B. Who are you proposing to be the primary psychologist if awarded this contract? <br /> Describe that person's knowledge base regarding the specifications listed in <br /> Section 2. List their education, years practicing, years in the industry, and <br /> years with the firm, etc. Provide a copy of their license and certifications. <br /> C. Describe your experience in diagnosis of first respondents and secondary <br /> trauma. <br /> D. Describe your experience with Public Safety psychological testing and <br /> evaluation. Include any specific experience working with firefighters. <br /> E. Describe your forensic psychology skills and experience. <br /> F. Describe your Membership and participation in nationally recognized <br /> Psychology or Psychiatric professional groups. <br /> G. Provide documentation of professional publication in journals, articles, etc. <br /> H. Describe your specialized training with military or law enforcement groups; <br /> such as the F.B.I. National Academy, Federal or State Police Academies, etc. <br /> I. Describe how you acquire and maintain the staff/personnel possessing the <br /> qualifications and capabilities called for in this RFP. <br /> J. What is your staff turnover rate annually for the past three years? <br /> K. What characteristics most distinguish your organization from your competitors? <br /> 2. Technical Capability, Approach, and Capacity <br /> A. Describe your professional / commercial facility and staffing to provide testing <br /> and other related services. Where is the office located and what is is the <br /> address? What are your office hours? <br /> B. Provide a sample of the complete testing packet for a pre-employment <br /> screening that will be utilized. <br /> C. Describe the reports that will be provided to the Fire Department. Detail how <br /> the reports will summarize major findings such as likelihood that the applicant <br /> will be a successful firefighter, potential performance problems, whether there <br /> are reasons to believe the applicant exhibits any psychological traits or <br /> characteristics that would interfere with the successful performance of essential <br /> job tasks. <br /> D. What is your approach to this project? List the primary features or work tasks. <br /> Describe your execution, management, and control of the project. <br /> E. Describe your method for maintaining confidentiality of information obtained. <br /> Provide any disclosure and release forms provided to candidates. <br /> 14 <br />