SELF RATING QUESTIONAIRE
YOURS NAME ___________________________________________________________
COMPANY
_________________________________________________________
ADDRESS
_________________________________________________________
DATE
_________________________________________________________
INSTRUCTIONS
1. This questionnaire consists of 70 brief statements. Read each statement and decide how
well it describes you. Be honest about yourself.
2. Select one of the numbers below to indicate how well the statement describes you:
5
=
VERY WELL
4
=
WELL
3
=
SOMEWHAT
2
=
VERY LITTLE
1
=
NOT AT ALL
3. Write the number you select on the line to the right of each statement. Here is an
example.
I remain calm in stressful situation
2
The person who responded to the item above wrote a 2 indicating that the statement
described him or her very little.
4. Some statements may be similar, but no two are exactly alike.
5. Please answer all questions.
S.N
o
1
QUESTIONAIRE
I look for things that need to be done
VALUE
I like challenges and new opportunities
When faced with a difficult problem, I spend a lot of time trying to
find a solution
When starting a new task or project, I gather a great deal of
information
It bothers me when things are not done very well
I give much effort to my work
I find ways to do things faster
I plan a large project by breaking it down into smaller tasks
I think of unusual solutions to problems
10
I feel confident that I will succeed at whatever I try to do
11
I tell others when they have not performed as expected.
12
I get others to support my recommendations
13
I develop strategies to influence others
14
No matter who Im talking to Im a good listener.
15
I do things that need to be done before being asked to by others.
16
I prefer activities that I know well and with which I am comfortable.
17
I try several times to get people to do what I would like them to do.
18
I seek the advice of people who know a lot about the problems or
tasks I am working on.
19
It is important to me to do a high quality job
20
I work long hours and make personal sacrifices to complete jobs on
time
21
I am not good at using my time well
22
I think about the advantages and disadvantages of different ways of
accomplishing things.
23
I think of many new ideas
24
I change my mind if others disagree strongly with me.
25
If I am angry or upset with someone, I tell that person
26
I convince others of my ideas.
27
I do not spend much time thinking about how to influence others.
28
I feel resentful when I dont get my way.
29
I do things before it is clear that they must be done.
30
I notice opportunities to do new things.
31
When something gets in the way of what I am trying to do I deep on
trying to accomplish what I want.
32
I take action without seeking information.
33
My own work is better than that of other people I work with.
34
I do whatever it takes to complete a job
35
It bothers me when my time is wasted
36
I try to think of all the problems I may encounter and plan what to do
if each problem occurs
37
Once I have selected an approach to solving a problem, I do not
change that approach
38
When trying something difficult or challenging, I feel confident that I
will succeed.
39
It is difficult for me to order people to do things.
40
I get others to see how I will be able to accomplish what I set out to
do
41
I get important people to help we accomplish my goals
42
In the past, I have had failures
43
I take action before it is clear that I must
44
I try things that are very new and different from what I have done
before
45
When faced with a major difficulty, I quickly go on to other things
46
When working on a project for someone, I ask many questions to be
sure I understand what that person wants
47
When something I have been working on is satisfactory, I do not
spend extra time trying to make it better
48
When I am doing a job for someone, I make a special effort to make
sure that person is satisfied with my work
50
I find ways to do thing for less cost
51
I think of many ways to solve problems
52
I do things that are risky
53
When id disagree with others, if let them know
54
I am a very persuasive with others
55
In order to reach my goals, I think of solutions that benefit everyone
involved in a problem
56
There have been occasions when I took advantage of someone
57
I wait for direction from others before taking action
58
I take advantage of opportunities that arise
59
I try several ways to overcome things that get in the way of reaching
my goals
60
I go to several different sources to get information to help with tasks
or projects
61
I want the company I own to be the best of its type
62
I do not let my work interfere with my family or personal life
63
I get the most I can out of the money I have to accomplish a project
or task
64
I take a logical and systematic approach to activities
65
If one approach to a problem does not work, I think of another
approach
66
I stick with my decisions even if others disagree strongly with me
67
I tell people what they have to do, even if they do not want to do it
68
I cannot get people who have strong opinions or ideas to change
their minds
69
I get to know people who may be able to help me reach my goals
70
When I dont know something, I dont mind admitting it.
SCORING SHEET
INSTRUCTIONS:
1. Enter the ratings from the completed questionnaire on the lines above the item numbers
in parentheses. Notice that the item numbers in each column are consecutive, item
number 2 is below item number 1 and so forth.
2. Do the addition and subtraction indicate in each row to compute each competency score.
3. Add all competency scores to compute the total score.
RATINGS OF STATEMENTS SCORE
15
29
43
57
16
30
44
58
17
31
45
59
18
32
46
60
19
33
47
61
20
34
48
62
21
35
49
63
22
36
50
64
23
37
51
65
10
24
38
52
66
11
25
39
53
67
12
26
40
54
68
13
27
41
55
69
14
28
42
56
70
COMPETENCY
+6
Initiative
+6
Sees & Acts on Opportunities
+6
Persistence
+6
Information seeking
+6
Concern for High Quality of
Work
+6
Commitment to Work contract
+6
Efficiency Orientation
+6
Systematic Planning
+6
Problemsolving
+6
Self Confidence
+6
Assertiveness
+6
Persuasion
+6
Use of Influence Strategies
+1
8
Correction of Factor
CORRECTED SCORE SHEET
Origin
al
Score
Correcti
on
Number
Correct
ed Total
Initiative
Sees & Acts on Opportunities
Persistence
Information seeking
Concern for High Quality of Work
Commitment to Work contract
Efficiency Orientation
Systematic Planning
Problemsolving
Self Confidence
Assertiveness
Persuasion
Use of Influence Strategies
CORECTED TOTAL SCORE
This number depends on a persons Correction Factor Score and will be 7, 5, 3 or 0 are the same
for each competency. Use the instructions on the previous page to determine the correction
number.
COMPETENCY PROFILE SHEET FOR SELF-RATING QUESTIONNAIRE INSTRUCTIONS
1. Transfer the corrected competency score to the profile sheet by marking an X at the
appropriate point on the horizontal line for each competency.
2. Draw a heavy line over the
Initiative
Sees & Acts on Opportunities
Persistence
Information seeking
Concern for High Quality of Work
Commitment to Work contract
Efficiency Orientation
Systematic Planning
Problemsolving
10
Self Confidence
11
Assertiveness
12
Persuasion
13
Use of Influence Strategies
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
10
15
20
25
