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